c13 Flashcards
Phenylephrine (Neo-Synephrine) therapeutic class and pharmacologic class
Therapeutic Class: Nasal decongestant; mydriatic drug; antihypotensive
Pharmacologic Class: Adrenergic drug (sympathomimetic)
Prazosin (Minipress) therapeutic class and pharmacologic class
Therapeutic Class: Antihypertensive
Pharmacologic Class: Adrenergic-blocking drug
mechanism of action of Phenylephrine (Neo-Synephrine)
stimulate the sympathetic nervous system directly/indirectly
uses Phenylephrine (Neo-Synephrine)
produces many of the same responses as anticholinergics
- constricts blood vessels –> BP goes up and treats nasocongestion
severe reactions of Phenylephrine (Neo-Synephrine)
- death –> restrict IV use USE SMALL DOSES
MOA Prazosin (Minipress)
inhibit sympathetic nervous system
uses of Prazosin (Minipress)
- hypertension
- dysrhytmias
- angina
- heart failure
- benign prostatic hypertrophy BPH
- narrow-angle glaucoma
primary use of adrenergic-blocking drugs
hypertension
therapetuic and pharmacologic class of ibuprofen (advil, motrin)
Therapeutic Class: analgesic, anti-inflammatory drug, antipyretic
Pharmacologic Class: NSAID
ibuprofen (advil, motrin) uses
- mild to moderate pain
- fever
- inflammation
ibuprofen (advil, motrin) actions are due to what?
inhibition of prostaglandin synthesis
common indications of ibuprofen (advil, motrin)
- pain associated w/ chronic musculoskeletal disorders
- RA + osteoarthritis - headache
- dental pain
- dysmenoorhea
administration alerts of ibuprofen (advil, motrin
give the drug on an empty stomach
if nausea, vomiting, or abdominal pain occurs, give w/ food
adverse effects of ibuprofen (advil, motrin)
- nausea
- heartburn
- epigastric pain
- dizziness
- GI ulceration w/ occult or gross bleed MAY occur w/ high doses for prolonged periods
- renal impairment due to chronic use
black box warning for ibuprofen (advil, motrin)
- increased risk of serious thrombotic events
- MI
- stroke –> fatal
- increased risk of GI events including bleeding, ulceration, perforation of the stomach or intestines
- occurs more frequently in older adults
contraindications of ibuprofen (advil, motrin)
- pt w/ active peptic ulcers
- significant renal or hepatic impairment
- HF
- serious HTN
- stroke or MI
drug-drug interactions of ibuprofen (advil, motrin)
- anticoagulants and other coagulation modifiers
- aspirin –> decreases anti-inflammatory action
- antihypertensive action of diuretics, beta blockers, ACE inhibitors
treatment of overdose of ibuprofen (advil, motrin)
alkaline drug
therapetuic and pharmacologic class of prednisone
therapeutic class: anti-inflammatory drug
pharmacologic class: corticosteroid
uses of prednisone
- synthetic corticosteroid –> actions are the result of being metabolized to an active form
- duration = 4-10 days
- acute brochopasm
- antineoplastic agent
administration alerts of prednisone
- do not use if signs of system infection are present
2. slowly decrease dose if using more than 10 days
adverse effects of prednisone
- long-term therapy –> Cushing’s syndrome
contraindications of prednisone
active viral, bacterial, fungal, or protozoan infections
drug-drug interactions of prednisone
- concurrent use w/ amphotericin B or diuretics increases potassium loss
- can raise blood glucose levels –> pt with diabetes need insulin dose adjusted
therapetuic and phamacologic class of acetaminophen (tylenol)
therapeutic class: antipyretic and analgesic
pharmacologic class, centrally acting COX inhibitor
uses of acetaminophen (tylenol)
has no anti-inflmamtory properties –> ineffective in treating arthritis or pain caused by tissue swelling following injury
- TREATS FEVER
- relieves mild-moderate pain
- severe pain –> combined w/ opioids
action of acetaminophen (tylenol)
reduces fever by direct action at the level of hypothalamus and dilation of peripheral blood vessels, which enables sweating and dissipation of heat
does not cause GI bleeding or ulcers, like NSAIDS
administration alert of acetaminophen (tylenol)
- regular consumption of alcohol –> drug-induced hepatoxicity
destroys liver if overdose –> die
adverse effects of acetaminophen (tylenol)
liver + hypothalamus
- malnoursihed –> acut toxicity –> renal failure –> fatal
- acute toxicity: nausea, vomitting, chills, abdominal discomfort, and fatal hepatic necrosis
- liver damage risk
black box warning of acetaminophen (tylenol)
- potential to cause severe and fatal LIVER INJURY
2. serious allergic reactions w/ symptoms of angioedema, difficulty breathing, itching, or rash
contraindications of acetaminophen (tylenol)
chronic alcoholism
drug-drug interactions of acetaminophen (tylenol)
- inhibits warfarin metabolism
2. high dose or long term use –> elevated warfarin levels + bleeding
hepatitis B vaccine classes
vaccine
uses of hepatitis B vaccine
ppl at risk for exposre to hepatitis virus
- infants born to HBV-positive mothers
- HPV-infected blood exposure
- High-risk sexual practices (multiple partners)
- ppl who contract STIs repeatedly
- healthcare workers
- dialysis pt
- prisoners
- HBV areas of travel
how is Hep B vaccine produced and how many injections are needed?
recombinant DNA technology using yeast cells
3 IM injections; second dose is given 1 month after first, and third dose 6 months after first dose
contraindications of Hep B vaccine
hypersensitivity to yeast or HBV vaccine
- fever or active infections
- compromised cardiopulmonary status
drug-drug interaction of hep b
immunosuppresants will decrease effectiveness
classes of Interferon alfa-2b (intron-A)
therapeutic class: immunostimulant
pharmacologic class: interferon, biologic response modifier
actions/uses of Interferon alfa-2b (intron-A)
biologic response modifier prepared by recombinant DNA technology –> treat cancers and viral infections
available for IV, IM, and subcutaneous administration
administration alerts of Interferon alfa-2b (intron-A)
- provider experienced with its use
2. subcutaneous administration is recommended for pt at risk for bleeding
adverse effects of Interferon alfa-2b (intron-A)
flulike syndrome of fever, chills, dizziness, fatigue
headache, nausea, vomiting, diarrhea, and anorexia, depression, suicidal ideation
serious toxicity –> immunosuppression, hepatotoxicity, neurotoxicity
black box warning of Interferon alfa-2b (intron-A)
cause aggravate fatal or life-threaning neuropsychiatric, autoimmune, ischemic, or infectious disorders
contraindications of Interferon alfa-2b (intron-A)
hypersenstivity to IFNs, autoimmune hepatitis, and hepatic decompensation
neonates and infants
cyclosporine (gengraf, neoral, sandimmune) classes
therapeutic: immunosuppressant
pharmacologic: calcineurin inhibitor
actions and uses of cyclosporine (gengraf, neoral, sandimmune)
- obtained from a soil fungus that inhibits helper T cells
- less toxic to bone marrow cells
- used in combo w/ high doses of corticosteroid
- approved for prophylaxis of kidney, heart, liver transplant reject; psoriasis, xerophthalmia
adverse effects of cyclosporine (gengraf, neoral, sandimmune)
- kidneys
- reduced urine output - hypertension and tremor
- headache, gingival hyperplasia, elevated hepatic enzymes
black box warning of cyclosporine (gengraf, neoral, sandimmune)
only adminstered by healthcare providers experienced
serious infections and possible malignancies
monitor renal function
penicillin G classes
therapetuic: antibacterial
pharacologic: cell wall inhibitor, natural penicillin
penicillin G uses + actions
- drug of choice against streptococci, pneumococci, and staphylococci organisms that do not produce penicillinase and are shown to be susceptible by C&S testing
- gonorrhea and syphilis
- given by IV + IM
- pencilin V and amoxicillin –> oral penicillin therapy is desired
adverse effects of penicillin G
diarrhea, nausea, and vomiting
anaphylaxis
late hypersenetivity
contraindications of penicillin G
pt with severe renal disease
cefazolin (ancef, kefzol) classes
therapeutic class: antibacterial
pharmacologic class: cell wall inhibitor: 1st generation cephalosporin
actions and uses of cefazolin (ancef, kefzol)
- beta-lactam antibiotic used for treatment and prophylaxis of bacterial –> susceptible gram-positive organisms
- respiratory tract, urinary tract, skin structures, biliary tract, bones, joints
NOT effective against MRSA
longer half-life –> less frequent dosing
adverse effects of cefazolin (ancef, kefzol)
rash + diarrhea
pain + phlebitis can occur at IM injection sites
seizures are rare
contraindications of cefazolin (ancef, kefzol)
extensively excreted by kidneys –> pt w/ severe renal disease
Tetracycline (sumycin, others) classes
therapeutic: antibacterial
pharmacologic: tetracycline; protein synthesis inhibitor
actions/uses of Tetracycline (sumycin, others)
broad range of gram-positive + gram-negative, including chlmaydia, rickettsiae, mycoplasma
effective aggainst H. pylori
given pO
topical + oral preparations treat acne
adverse effects of Tetracycline (sumycin, others)
tendency to affect vaginal, oral, and intestinal flora –> superinfection
nausea, vomiting, epigastric burning, diarrhea
teeth discoloration
photosensitivity
contraindications of Tetracycline (sumycin, others)
severe renal or hepatic impairment
Erythromycin (Eryc, Erythrocin, others) classes
therapeutic: antibacterial
pharmacologic: macrolide; protein synthesis inhibitor
actions/uses of Erythromycin (Eryc, Erythrocin, others)
- inactivated by stomach acid –> coated, acid-resistant tablets or capsules that dissolve in small intestine
- pt who are unable to tolerate penicillins or have pencillin-resistnat infection
- effective against most gram-positive bacteria
adverse effects of Erythromycin (Eryc, Erythrocin, others)
nausea, abdominal cramping, vomitting
hearing loss, vertigo, dizziness
cardiotoxic and pose a risk for potentially fatal dysrhythmias
Gentamicin (Garamycin, others) classes
therapeutic: antibacteriall
pharmacologic: aminoglycoside; protein synthesis inhibitor
uses/actions of Gentamicin (Garamycin, others)
broad-specturm bactericidal antibiotic usually prescribed for serious urinary, respiratory, nervous, or GI infections when less toxic antibiotics are contraindicated
not absorbed by the oral route
how to monitor therapeutic range of Gentamicin (Garamycin, others)
check serum drug levels
adverse effects of Gentamicin (Garamycin, others)
rash, nausea, vomitting, fatigue
black box warnings of Gentamicin (Garamycin, others)
neurotoxicity may manifest as ototoxicity and produce a loss of hearing or balance
tinnitus, vertigo, persistant headaches –> signs of ototoxicity
neuromuscluar blockade and respiratory paralysis
severe neuromscular weakness
signs of reduced kidney function include oliguria, proteinuria, and elevated BUN and creatinine levels
contraindicaitons of Gentamicin (Garamycin, others)
pt w/ impaired renal function or those w/ hearing loss
Ciprofloxacin (Cipro) classes
therapeutic: antibacterial
pharmacologic: fluoroquinolone; bacterial DNA synthesis inhibitor
actions/uses of Ciprofloxacin (Cipro)
inhibiting bacterial DNA gyrase, affects bacterial replication and DNA repair
more effective against gram-negative
UTI, sinusitis, pneumonia, skin, bone and joint infections, infectious diarrhea, and certain eye infections
adverse effects of Ciprofloxacin (Cipro)
nausea, vomitting, diarrhea
dont take w/ antacids or mineral supplements bc drug absorption will be diminshed
black box warning of Ciprofloxacin (Cipro)
tendinitis and tendon rupture
contraindications of Ciprofloxacin (Cipro)
pt experiences pain or inflammation of tendon
trimethoprim-sulfamethoxazole (bactrim, septra) classes
therapeutic: antibacterial
pharmacologic: sulfonamide; folic acid inhibitor
actions/uses of trimethoprim-sulfamethoxazole (bactrim, septra)
UTIs
inhibits bacterial metabolism of folic acid
both SMZ and TMP are synergestic
-development of resistnace is lower
adverse effects of trimethoprim-sulfamethoxazole (bactrim, septra)
nausea and vomiting
pt w/ pre-existing kidney disease –> crystalluria, oliguria, renal failure
avoid direct sunlight
contraindications of trimethoprim-sulfamethoxazole (bactrim, septra)
documented megaloblastic anemia due to folate defiiency should not receive this drug
Isoniazid (INH) classes
therapetuic: antituberculosis drug
pharmacologic: mycolic acid inhibitor
Isoniazid (INH) uses/actions
first-line drug for TB
inhibit synthesis of mycolic acids, which are essential components of mycobacterial cell walls
bactericidal for actively growing organsims but bacteriostatic for dorman mycobacteria
may be used alone for chemoprophylaxis, or in combo w/ other antituberculosis drugs for treating active disease
adverse effects of Isoniazid (INH)
numbness of hands/feet, rash, fever
neurotoxicity, convulsions, optic neuritis, dizziness, coma, memory loss, psychoses
black box warning of Isoniazid (INH)
hepatoxociity
jaundince, fatigue, elevated hepatic enzymes, loss of appetite
contraindications of Isoniazid (INH)
severe hepatic impairment
mechanism of action of pencillin
kill bacteria by disrupting cell walls
most effective on gram-positive bacteria
primary use of pencillin
meninigtis; skin bone and joint infections; stomach infections; blood and valve infections; gas gangrene; tetanus; anthrax; sickle-cell anemia in infants
staph, strep, pneumonia
adverse effects of penicilin
safest class of antibiotics
bacteria can become resisitnat
allergy is possible
lowered red/ whtie blood cell and platelet levels
cephalosporins action
bind to bacterial cell wall, inhibit cell-wall synthesis
act w/ broad-spectrum activity against gram-negative organisms
5 generations w/ increased extent of activity
primary use of cephalosporins
serious infections of lower respiratory tract, central nervous system genitourinary system, nbones bloods and joints
adverse effects of cephalosporins
safe drugs
adverse effects similar to penicllins
MOA tetracycline
effective agianst broad range of gram-positive + gram-negative organisms
primary use of tetracycline
Rocky Mountain spotted fever
typhus, cholera, Lyme disease, peptic ulcers, and Chlamydia; newer ones for drug-resistnat intra-abdominal infections + complicated skin-structure infections, especially those caused by MRSA
adverse effects of tetracycline
superinfections, nausea, vomiting, diarrhea, teeth discoloration, photsensitivey; drug resistance
MOA macrolides
inhibits protein synthesis by binding to bacterial ribosome
effective against most gram-positivie and many gram-negative bacteria
primary use of macrolides
- whooping cough
- legionnaire’s disease
- streptococcus
- H. influenzae
- Mycoplasma pneumonia
adverse effects of macrolides
nausea, abdominal cramping and vomiting, diarrhea, superinfections, concern about resistant bacterial strains
aminoglycosides MOA
inhibit bacterial protein synthesis
primary uses of aminoglycosides
serious systemic infections caused by aerobic gram-negative bacteria, myobacteria, and some protozoans
adverse effects of aminoglycosides
more toxic than other antibacterial classes, with serious systemic adverse effects
MOA fluoroquinolones
inhibit bacterial DNA synthesis by inhibiting DNA gyrase + topoisomerase IV
primary use of fluoroquinolones
respiratory infections, GI, and genitourinary tract infections
skin + soft tissue infections
UTIs
prophylaxis of anthrax infection
adverse effects of fluroquinolones
nausea, vomiting, diarrhea, sleep disturbances, headche, dizziness,
most serious: dysrhythmias, hepatotoxicity
MOA sulfonamides
suppress bacterial growth by inhibitng bacterial synthesis of folic acid
sulfonamides primary use
UTI, pneumocystis carinii pneumonia, shigella infections of small bowel
adverse effects of sulfonamides
formulation of crystals in the urine, hypersnsitivty reacitons, nausea, vomiting,
serious adverse effects: agranulocytoiss, acute hemolytics anemia, and aplastic anemia
first-line drugs of TB
initial phase: 2months daily therapy with :
- isoniazid
- rifampin
- ethambutol
continuation phase: 2 months isoniazid and rifampin 2-3x per week
chemoprophylaxis for TB
anti-tubercular drugs used to prevent disease in high-risk populations
- patients w/ aids
- close contacts + family members of recently infected tuberculosis patients
- patients who are HIV positive and are receiving immunosuppressant drugs