Exam 3 Flashcards
class of Clotrimazole/ Lotrimin
antifungal
indication of Clotrimazole/ Lotrimin
superficial mycoses such as tinea pedis, tinea cruris and ring worm as well as yeast vaginitis
MOA of Clotrimazole/ Lotrimin
binds to ergosterol molecules on the fungal cell membrane and causes membrane leakage during cell division
class of Nystatin/ Mycostatin
antifungal, may be used both topically and systemically
indication of Nystatin/ Mycostatin
superficial mycoses such as ring worm, tinea pedis, tinea cruris and treatment of oral candidiasis (thrush) as well as esophageal and vaginal Candida Cryptococcus is also sensitive to Nystatin
MOA of Nystatin/ Mycostatin
binds to ergosterol molecules on fungal cell membrane resulting in loss of membrane integrity death of the fungal cell
Nystatin/ Mycostatin is used as prophylaxis in patients who are at risk for
fungal infections, such as AIDS patients with a low CD4+ count and patients receiving chemotherapy
side effects of Nystatin/ Mycostatin
negligible oral absorption allows for diminished side effects. N/V possible. GI absorption also minimal and most orally administered Nystatin is passed unchanged in stool.
current drug of choice for onychomycosis
Terbinafine/ Lamisil
Terbinafine/ Lamisil is mainly effective on group of fungi known as
dermatophytes
Terbinafine/ Lamisil treats onychomycosis of the toenail or fingernail due to
dermatophyte Tinea unguium
common side effects of Terbinafine/ Lamisil
discomfort, diarrhea, and nausea as well as headache. Less commonly, elevated liver enzymes, hepatitis, liver damage and even liver failure have been reported
class of Fluconazole/ Diflucan
antifungal, both topical and systemic
indication of Fluconazole/ Diflucan
superficial mycoses such as yeast vaginitis as well as systemic or meningeal mycotic infections by fungi such as Cryptococcus or Histoplasmosis
MOA of Fluconazole/ Diflucan
inhibits fungal membrane synthesis
anti-fungal that can be used as vaginal suppository for yeast vaginitis
Fluconazole/ Diflucan
Fluconazole/ Diflucan can inhibit
cytochrome enzyme systems responsible for metabolism of many drugs
side effects of Fluconazole/ Diflucan
nausea and vomiting with oral and IV doses
class of Amphotericin B/Amphocil
antimycotic
indication of Amphotericin B/Amphocil
systemic fungal infections such as systemic Candidadiasis, Histoplasmosis, Coccidiomycosis, Aspergillus and Blastomyces
MOA of Amphotericin B/Amphocil
binds to ergosterol molecules on the fungal cell membrane and disrupts membrane integrity, resulting in death of the fungal cell
Amphotericin B/Amphocil may for used via intrathecal route for
fungal meningitis or fungal brain abscess
side effects of Amphotericin B/Amphocil
Very severe side effect profile. Fevers and shaking chills are common. (“Ampho-terrible” and “shake and bake” are terms used to describe the severe side effects). Pre-treatment with Benadryl, NSAIDs or Prednisone often used to mitigate the fever and chills. Hypotension, renal impairment and severe anemia can occur.
Isoniazid (INH) / Nitrazid class
antibiotic
indication of Isoniazid (INH) / Nitrazid
tuberculosis
MOA of Isoniazid (INH) / Nitrazid
Isoniazid is a pro-drug and must be activated by bacterial catalase. The activated form of INH inhibits the synthesis of mycolic acid in the mycobacterial cell wall
lower doses of Isoniazid (INH) / Nitrazid should be given to patients with
chronic liver disease
side effects of Isoniazid (INH) / Nitrazid
rash, abnormal liver function tests, hepatitis, sideroblastic anemia, peripheral neuropathy and CNS effects. The possible hepatotoxicity of INH is best avoided by close clinical monitoring of the patient, specifically for signs of nausea, vomiting, and abdominal pain as well as monitoring liver function tests
Isoniazid competes with an enzyme that is needed to produce
pyridoxine
peripheral neuropathy is a common side effect when using ____ and is caused by
when using Isoniazid and is caused by INH induced pyridoxine deficiency
peripheral neuropathy caused by ___ may be reduced or avoided altogether by concurrent
caused by Isoniazid, avoided by supplementation with pyridoxine (vit B6 - 10to 50 mg/day)
class of Rifampin/ Rifadin
antibiotic
indication of Rifampin/ Rifadin
tuberculosis, Methicillin-resistant Staphylococcus aureus (MRSA) and prophylactic therapy against meningococcal infection from Neisseria meningitidis
MOA of Rifampin/ Rifadin
inhibits DNA-dependent RNA polymerase in bacterial cells thus preventing transcription of messenger RNA and subsequent translation to protein production
weird side effect of Rifampin/ Rifadin
can cause certain bodily fluids, such as urine and tears, to become orange-red in color. may permanently stain soft contain lenses
side effects of Rifampin/ Rifadin
fever, upset stomach, nausea, vomiting, rash. hepatotoxicity with liver damage and jaundice can occur. liver function tests must be followed.
Standard treatment of TB
Rifampin/Rifadin, Isoniazid (INH)/Nitrazid, Pyrazinamide/Pyrazinamide, Ethambutol/Myambutol
drug that is a nicotinamide analog with an unknown mechanism of action
Pyrazinamide
MOA of Ethambutol
inhibits mycolic acid synthesis in the mycobacterial cell wall
the drugs utilized for M. tuberculosis can also be used for other mycobacterial diseases such as
leprosy
Multi-drug resistant tuberculosis (MDR-TB) is defined as TB that is resistant to at least
Isoniazid and Rifampin
Rick factors for MDR-TB include
exposure to patient with MDR-TB, HIV infection, previous incarceration, failure to respond to standard TB treatment, and relapse following standard TB treatment
acronym for CDC recommended empiric treatment of patient suspected of having MDR-TB
SHREZ MC
7 drugs that make up SHREZ MC are
Streptomycin + Hydrazine + Rifampin + Ethambutol + pyraZinamide + Moxifloxacin (a fluoroquinolone) and Cycloserine (a broad spectrum antibiotic)
Viruses that can be treated with anti-virals
URI viruses including influenza types A and B and respiratory syncytial virus (RSV)…herpesviruses, cytomegalovirus, HIV, viral hepatitis B and C
US Centers for Disease Control and Prevention recommends the use of what for treatment/prevention of swine flu virus
Tamiflu (Oseltamivir) or Relenza (Zanamivir)
class of Oseltamivir/ Tamiflu
anti-viral
indication of Oseltamivir/ Tamiflu
treatment (and prevention) of infections due to influenza A and B virus in adults and in children at least one year of age - when given within 48 hours of symptoms of infections. Tamiflu has also shown effectiveness for H5N1 known as avian flu.
how soon do you need to administer Oseltamivir/ Tamiflu for it to be effective
within 48 hours of symptoms
MOA of Oseltamivir/ Tamiflu
neuramidase inihbitiion, preventiing virus from budding off from cell. Oseltamivir/ Tamiflu was first orally active neuraminidase inhibitor to be commercially developed.
doses of Oseltamivir/ Tamiflu are decreased for children and patients with
renal impairment
side effects of Oseltamivir/ Tamiflu
abdominal pain nausea, vomiting and headache…concern about potential adverse effects including delirium, hallucinations, depression and increased suicidal ideation
Zanamivir/ Relenza is formulated as a
powder that is delivered via the respiratory tract by an oral inhaler
Zanamivir/ Relenza is not recommended in people with
history of asthma or COPD due to risk of serious bronchospasm
class of Zanamivir/ Relenza
anti-viral
indication of Zanamivir/ Relenza
influenza treaetment and/or prophylaxis
MOA of Zanamivir/ Relenza
neuramidase inhibitor
route of Zanamivir/ Relenza
inhaled route
side effects of Zanamivir/ Relenza
N/V. Post treatment diarrhea, vaginal candidiasis and thrush is negligible.
drug that is used as a treatment for the early stages of Parkinson’s disease
Amandatine/ Symmetrel…best used as short term therapy (6-12 months)…its an anti-viral that was recommended as prophylaxis for influenza
primary drug for herpesvirus infection
Acyclovir/Zovirax
class of Acyclovir/ Zovirax
anti-viral
indication of Acyclovir/ Zovirax
herpesvirus infections such as HSV-1, HSV-2 and Herpes zoster (chicken pox and shingles)
MOA of Acyclovir/ Zovirax
guanosine analog that is incorporated into the virus DNA and inhibits further viral synthesis
Acyclovir/ Zovirax only works against
viruses that are actively replicating and is ineffective against latent viruses
Does Acyclovir/ Zovirax actively cross the blood barrier?
Yes. It can be used to treat herpes meningitis and encephalitis.
Bizarre possible form of Acyclovir/ Zovirax
topical ointment
side effects of Acyclovir/ Zovirax
Dependent upon route of administration. Headache, nausea and vomiting can occur with oral dose. Transient renal insufficiency can occur with higher IV doses and skin irritation can occur with topical doses.
current treatment for HIV infection consists of
Highly Active Antiretroviral Therapy or HAART
4 main categories of drugs used as treatment or prophylaxis against HIV
reverse transcriptase inhibitors (RTIs), protease inhibitors (PIs), fusion inhibitors, integrase inhibitors
standard HAART drug classes
two nucleoside reverse transcriptase inhibitors plus either a non-nucleoside reverse transcriptase inhibitor (NNRTI) or a protease inhibitor (PI).
what do RTIs do
block enzymatic function of reverse transcriptase and prevent the completion of synthesis of double-stranded viral DNA thus preventing HIV from multiplying.
3 main forms of RTIs
Nucleoside reverse transcriptase inhibitors, Nucleotide reverse transcriptase inhibitors, Non-nucleoside reverse transcriptase inhibitors
primary Nucleoside reverse transcriptase inhibitor
Zidovudine (AZT)/ Retrovir
class of Zidovudine (AZT)/ Retrovir
anti-viral, nucleoside reverse transcriptase inhibitor
indication of Zidovudine (AZT)/ Retrovir
HIV
MOA of Zidovudine (AZT)/ Retrovir
pyrimidine analog that is incorporated into the viral DNA by reverse transcriptase. Incorporation into viral DNA terminates further replication
side effects of Zidovudine (AZT)/ Retrovir
Headaches are common. Potentially toxic to bone marrow with severe anemia and leukopenia in patients receiving high doses.
Unlike nucleoside RTIs, which bind at the enzyme’s active site, NNRTIs bind within
a pocket termed the NNRTI pocket
____ inhibitors are currently used to treat HIV and Hep C
protease inhibitors
primary protease inhibitor
Saquinavir/ Invirase
class of Saquinavir/ Invirase
anti-viral, protease inhibitor
indication of Saquinavir/ Invirase
HIV, Hep C
MOA of Saquinavir/ Invirase
Protease enzyme inhibition prevents viral protein molecules from being cleaved into smaller fragments, which prevents both the replication of the virus within the cell and the release of mature viral particles from an infected cell.
side effects of Saquinavir/ Invirase
Mostly G.I. i.e. abdominal discomfort, nausea, vomiting and diarrhea.
interferon alpha is for
Hep C
Interferon Beta is for
relapsing multiple sclerosis
interferon gamme is for
chronic granulomatous diseases
class of Interferon alpha
anti-viral
indication of Interferon alpha
chronic hep B and C, genital warts due to HPV, Kaposi’s sarcoma and hairy cell leukemia
MOA of Interferon alpha
Interferon is a naturally occurring glycoprotein that interferes with the ability of a virus to infect cells. Interferon appears to induce host cell enzymes that inhibit viral RNA translation and subsequent viral synthesis within the infected host cell.
Side effects of Interferon alpha
Arthralgias, myalgias, fever, lethargy, headache, dizziness, hair thinning and depression.
what is Pegylated interferon alpha
a form of interferon in which polyethylene glycol is added to make the interferon last longer in the body.
When treating hepatitis C, pegylated interferon is often administered with the drug
Ribavirin
what type of vaccine is most likely to confer life-long immunity
live/attenuated virus vaccinations
live vaccinations are typically not given to
people who are immunocompromised
name the two recombinant protein vaccinations
Hep B and HPV
Live Attenuated Influenza Vaccine (LAIV) is delivered as
a nasal spray (FluMist)
Gardasil and Cervarix protect against what two types of HPV
HPV 16 and 18
Gardasil also protects against what two HPV types that cause genital warts
6 and 11
Most commonly reported side effects of HPV vaccine
lightheadedness, pain and swelling at the injection site.
what are adjuvants
substances added to boost the immune response to a vaccine
examples of aluminum containing vaccines
Hep A, Hep B, and DTaP
as of 2005 the only childhood vaccine in the US that still contained more than trace amounts of Thiomersal is
the influenza vaccine
what are the two types of Influenza vaccination
LAIV and TIV (trivalent inactivated vaccine)
what type of vaccine is Hib
conjugate
what type of vaccine is Meningococcal
conjugate
for people that are asplenic, revaccination at period intervals is recommended for what vaccine
pneumococcal vaccine…also recommended for nephrotic syndrome
Psyllium/ Metamucil class
fiber laxative
indication of Psyllium/ Metamucil
constipation, irritable bowel, reduction of colon cancer risk, reduction of cholesterol levels and heart disease risk
MOA of Psyllium/ Metamucil
contains soluble and insoluble fiber. adds bulk to stool as well as absorbing fluid into the feces to soften the stool
Side effects of Psyllium/ Metamucil
may cause diarrhea. avoid if any suspicion of intestinal obstruction. powder and capsules are gluten free, but wafers contain gluten
class of Docusate/ Colace
stool softener
indication of Docusate/ Colace
constipation, hemorrhoids. prophylaxis in patients who should no strain during bowel movement (i.e. after anorectal surgery, MI)
MOA of Docusate/ Colace
anionic surfactant
side effects of Docusate/ Colace
flatulence, bloating, abdominal cramping. may cause diarrhea. avoid oral use if suspicion of intestinal obstruction.
class of Magnesium Hydroxide/ Milk of Magnesia
osmotic laxative, antacid
MOA of Magnesium Hydroxide/
Milk of Magnesia
magnesium salts are poorly absorbed by the GI tract and thus act as osmotic agents to draw water into the lumen of the GI tract
indication of Magnesium Hydroxide/
Milk of Magnesia
constipation, indigestion
side effects of Magnesium Hydroxide/
Milk of Magnesia
Diarrhea, cramping, abdominal pain. May precipitate or exacerbate electrolyte imbalances. Patients with severe chronic kidney disease are at greater risk for possible hypermagnesemia. Avoid use if any suspicion of intestinal obstruction.
Bisacodyl/ Dulcolax class
stimulative laxative
MOA of Bisacodyl/ Dulcolax
increases intestinal motility
indication of Bisacodyl/ Dulcolax
constipation
side effects of Bisacodyl/ Dulcolax
Diarrhea, abdominal cramping, sweating. Possible laxative dependence with prolonged use. Definitely avoid use if any suspicion of intestinal obstruction.
class of Loperamide/ Imodium
antidiarrheal - analog of Meperidine
MOA of Loperamide/ Imodium
diminished peristalsis due to activation of opiate receptors in GI tract. Loperamide is an opioid receptor agonist and acts on the u-opioid receptors in the myenteric plexus within the large intestines. It does not affect the central nervous system like other opioids. Dimished activity of the myenteric plexus decreases the motility of the circular and longitudinal smooth muscles of the intestinal wall. This increases the amount of time substances stay in the intestine, allowing for more water to be absorbed out of the fecal matter.
indication of Loperamide/ Imodium
acute diarrhea and the management of chronic diarrhea in patients with inflammatory bowel disease
side effects of Loperamide/ Imodium
Dizziness, headache. Generally, not to be used in parasitic or bacterial infections accompanied by fever. Not to be used in severe colitis due to risk of toxic megacolon.
class of Diphenoxylate with Atropine/ Lomotil
antidiarrheal
MOA of Diphenoxylate with
Atropine/ Lomotil
combination of morphine analog and acetylcholine inhibitor results in diminished peristalsis
indication of Diphenoxylate with
Atropine/ Lomotil
acute diarrhea
what antidiarrheal is generally no indicated beyond 48 hours
Diphenoxylate with
Atropine/ Lomotil
side effects of Diphenoxylate with
Atropine/ Lomotil
Dry mouth is quite common urinary retention, possible abdominal pain, constipation, (atropine effects). Generally, avoid when diarrhea is accompanied by fever. Not to be used in diarrhea due to bacterial or parasitic infections. Contraindicated in patients with severe colitis due to risk of toxic megacolon.
What is the active ingredient in Kaopectate
Bismuth subsalicylate (same as Pepto-Bismol). It was formerly kaolin clay (kaolinite) and pectin.
mild nausea and vomiting may respond to
antihistamines
moderate to severe N/V may require more potent agents that block
the 5-HT3 receptor sites
Meclizine/ Antivert class
antiemetic
MOA of Meclizine/ Antivert
H1 Histamine blocker
indication of Meclizine/ Antivert
mild to moderate nausea such as in motion sickness or vertigo
side effects of Meclizine/ Antivert
drowsiness, dizziness, dry mouth, urinary retention
class of Metoclopramide/ Reglan
antiemetic/pro-kinetic
MOA of Metoclopramide/ Reglan
dopamine 2 blocker and mixed serotonin 3 antagonist/serotonin 4 agonist
indication of Metoclopramide/ Reglan
mild to moderate nausea, gastric stasis (i.e. after gastric surgery or diabetic gastroparesis). Also used in GERD.
side effects of Metoclopramide/ Reglan
Drowsiness, dizziness and headache. It should be used with caution in Parkinson’s disease since, as a dopamine antagonist, it may worsen symptoms. Contraindicated in patients with suspected bowel obstruction.
what drug increases peristalsis of the jejunum and duodenum, increases tone and amplitude of gastric contractions, and relaxes the pyloric sphincter tone.
Metoclopramide/Reglan
class of Ondansetron/ Zofran
antiemetic
MOA of Ondansetron/ Zofran
blockade of serotonin (5HT3) receptor sites results in significant anti-nausea effect
indication of Ondansetron/ Zofran
severe nausea
what is an effective agent for severe nausea due to various chemotherapeutic agents (given approx. 30 min prior)
Ondansetron/ Zofran
side effects of Ondansetron/ Zofran
dizziness, headache
Emetic/ Syrup of Ipecac class
emetic
MOA of Emetic/ Syrup of Ipecac
stimulation of medullary chemoreceptor trigger zone and local irritant of GI tract
indication of Emetic/ Syrup of Ipecac
induction of vomiting for drug overdose and certain poisonings
Emetic/ Syrup of Ipecac is not given with
charcoal, will absorb the drug
side effects of Emetic/ Syrup of Ipecac
abdominal muscle spasm (often lasting hours after stomach contents are emptied), dizziness and dehydration
class of Calcium carbonate/ Tums
antacid
MOA of Calcium carbonate/ Tums
neutralization of stomach acid, reducing mucosal irritation
indication of Calcium carbonate/ Tums
symptomatic relief of gastric acid irritation
side effects of Calcium carbonate/ Tums
Constipation. Drugs which alter the stomach or duodenal pH can alter the absorption of nutrients as well as the absorption other oral drugs. Increased pH may also inhibit protection against digested pathogens.
class of Ranitidine/ Zantac
H2 Histamine receptor antagonist
MOA of Ranitidine/ Zantac
blocks the action of histamine on parietal cells in the stomach, decreasing acid production by these cells
indication of Ranitidine/ Zantac
Gastritis, PUD, GERD
side effects of Ranitidine/ Zantac
Generally well tolerated. Greater side effect profile when given I.V. Headache, confusion, dizziness, rash. Drugs which alter the stomach or duodenal pH can alter the absorption of nutrients as well as the absorption other oral drugs. Increased pH may also inhibit protection against digested pathogens.
class of Omeprazole/ Prilosec
proton pump inhibitor
MOA of Omeprazole/ Prilosec
inhibits H+/K+ ATPase pump of parietal cells thus reducing acid secretion
indication of Omeprazole/ Prilosec
gastritis, PUD, GERD
side effects of Omeprazole/ Prilosec
Headaches, dizziness, diarrhea. Drugs which alter the stomach or duodenal pH can alter the absorption of nutrients as well as the absorption other oral drugs. Increased pH may also inhibit protection against digested pathogens.
Esomeprazole/ Nexium–what is it
single enantiomer form of Omeprazole that AstraZeneca made because they lost their patent
rank least to most potent drug classes for stomach acid
antacid, H2 blocker, PPI
therapy of choice for PUD
triple therapy for 7-14 days for PUD due to H Pylori
two forms of Triple Therapy for PUD
Proton Pump Inhibitor and Bismuth based
what is proton pump inhibitor based triple therapy
a PPI and 2 antibiotics for 1-2 weeks
what is Bismuth based triple therapy
Subsalicylate and 2 antibiotics for 1-2 weeks
how does Bismuth work for H Pylori
shown to damage the cell wall of H Pylori and other bacteria as well as reducing the bacterial adherence to mucosal cells
what increases risk of travelers diarrhea?
blocking stomach acid what do
what promotes mucosal healing
H2 histamine blockers to block acid production or PPIs to do so
why is monotherapy discouraged for H Pylori
Although the growth of H. pylori is readily suppressed by a single antibiotic, antimicrobial monotherapy is discouraged because it does not eradicate the organism and leads to increased risk for the selection of resistant strains.
antibiotics used in Triple Therapy for PUD
Amoxicillin, Erythromycin, Clarithromycin (Biaxin), Tetracycline or Metronidazole (Flagyl)…NOT Zithromax
the active moiety of all the aminosalicylates used to treat inflammatory bowel disease is
5-aminosalicylic acid (5-ASA), also called Mesalamine
class of 5-ASA/ Mesalamine
aminosalicylates
indications of 5-ASA/ Mesalamine
IBD
MOA of 5-ASA/ Mesalamine
inhibition of leukotriene production, anti-prostaglandin and anti-oxidant effects
side effects of 5-ASA/ Mesalamine
N/V, diarrhea, and abdominal pain. Nephrotoxicity can occur
5-ASA/ Mesalamine is delivered as a ___ drug
pro-drug to allow for release of drug at ileum of beyond
5-ASA/ Mesalamine, is it more useful for Crohn’s or UC
far more useful for UC
Who benefits more from antibiotics: Crohn’s or UC?
Patients with Crohn’s disease
two of the most commonly used antibiotics for treating Crohn’s disease
Metronidazole/Flagyl and Ciprofloxacin/Ciprofloxin
Metronidazole should not be taken by
patient’s consuming alcohol
Ciprofloxacin is notable for its affinity to
calcium and for increased risk for occurrence of tendon rupture in patients taking this drug
drug approved by the FDA for the treatment of traveler’s diarrhea and hepatic encephalopathy
Rifaximin/Ixifaxin
Prednisone is a pro-drug that is converted in the liver into
prenisolone, which is the most active form of the drug
Prednisone/ Deltasone class
glucocorticoid/corticosteroid
indications of Prednisone/ Deltasone
preferred drug for reactive airways disease or moderate to severe allergic reaction. Important for leukemia reaction.
MOA of Prednisone/ Deltasone
affects gene transcription to either stimulate or repress protein production
side effects of Prednisone/ Deltasone
Side effects include reduced resistance to infections, hypertension, hyperglycemia and possible diabetes mellitus, severe bone loss, avascular necrosis, cataracts, myopathy, thinning of skin, diminished wound healing, easy bruising, insomnia and mental status changes and possible adrenal suppression.
Increased appetite is a commonly reported side effect as is weight gain from salt and water retention.
Budesonide/ Entocort is used to treat
mild to moderate Crohn’s disease
what are immunomodulatory drugs often used for
weaning from prednisone and to maintain the length of remission
Azthioprine/ Immuran class
immunomodulator
indications of Azthioprine/ Immuran
IBD, rheumatoid arthritis and other auto-immune conditions, post-transplant cases (anti-rejection agent) and cancer chemotherapy
MOA of Azthioprine/ Immuran
inhibits purine synthesis, resulting in an anti-proliferative effect and induction of apoptosis of T-cells
Azathioprine/ Immuran is a ___ drug
pro-drug which is converted in the body to its active form called mercaptopurine (Purinethol)
side effects of Azathioprine/ Immuran
Side effects include nausea, fatigue, hair loss, and rash. Because Azthioprine suppresses the bone marrow, patients will be more susceptible to infection.
patients taking what drug are excluded from eligibility for blood donation
Azathioprine/ Immuran
Infliximib/ Remicade class
immunomodulator - TNF inhibitor
indications of Infliximib/ Remicade
IBD, rheumatoid arthritis, psoriasis and other auto-immune conditions
MOA of Infliximib/ Remicade
inhibits the pro-inflammatory cytokine, TNF-alpha
Infliximib/ Remicade is dosed every ___ or ___
every 2 weeks or every 4 weeks
side effects of Infliximib/ Remicade
Marked susceptibility to infection and sepsis, potential reactivation of hepatitis B, potential reactivation of tuberculosis, T-cell lymphoma and drug induced lupus
several medications are available to treat urge incontinence by
blocking acetylcholine action on the bladder and diminish detrusor muscle contraction
class of Oxybutynin/ Ditropan
anticholinergic med
indication of Oxybutynin/ Ditropan
used to relieve frequent urination and inability to control urination due to urge incontinence. also used for hyperhidrosis (hyper-active sweating)
MOA of Oxybutynin/ Ditropan
competitive antagonism of M3 subtype of the muscarinic acetylcholine receptor
side effects of Oxybutynin/ Ditropan
dry mouth, dry eyes, constipation, blurred vision, drowsiness dizziness and diminished sweating. Patients taking this medication should be instructed to use extra care not to become overheated during exercise to avoid the risk of heat stroke.
class of Tolterodine/ Detrol
anticholinergic med
indication of Tolterodine/ Detrol
used to relieve frequent urination and inability to control urination due to urge incontinence
MOA of Tolterodine/ Detrol
competitive antagonism of M2 and M3 subtypes of the muscarinic acetylcholine receptor
what antimuscarinic agent is marketed as having fewer side effects than other antimuscarinic agents
Tolterodine/ Detrol
Tolterodine/ Detrol and Oxybutynin/ Ditropan have potential interactions with
drugs metabolized by cytochrome P450
class of Imipramine/ Tofranil
tricyclic antidepressant, mainly used in the treatment of clinical depression but is also used in cases of urge incontinence and enuresis
MOA of Imipramine/ Tofranil
blocks reuptake of serotonin and norepinephrine and appears to diminish acetylcholine uptake in smooth muscle
side effects of Imipramine/ Tofranil
Dry mouth, blurred vision, constipation, insomnia, flushing, tremulousness and weight gain. Agitation, irritability, confusion, and delirium are also possible, particularly in the elderly.
2 very important things about Imipramine/ Tofranil
black box warning about increased risk for suicidal ideation and suicide. Overdose can be fatal due to a heart block.
drug used frequently for enuresis
Imipramine/ Tofranil
two main medication for management of BPH are
alpha blockers and 5alpha-reductase inhibitors
common side effects of alpha blockers include
orthostatic hypotension, fatigue, and nasal congestion
class of Tamsulosin/ Flomax
alpha 1 receptor antagonist
indication of Tamsulosin/ Flomax
BPH
MOA of Tamsulosin/ Flomax
smooth muscle relaxation via alpha adrenergic antagonism
side effects of Tamsulosin/ Flomax
possible retrograde ejaculation
class of Finasteride / Proscar
5 alpha-reductase inhibitor
indication of Finasteride / Proscar
BPH
MOA of Finasteride / Proscar
blocks conversion of testosterone to dihydrotestosterone
a lower dosage of Finasteride / Proscar is marketed for the treatment of
male pattern baldness. Drug is called Propecia.
side effects of Finasteride / Proscar (IMPORTANT)
Impotency. Women who are or who may become pregnant must not handle crushed or broken Finasteride tablets, because the medication could be absorbed through the skin. Category X.
the drug of choice for cystitis has been
TMP-Sulfa/Bactrim
drug that usually provides excellent coverage for UTI organisms
Ciprofloxin or other quinolones
avoid use of Ciprofloxin or other quinolones in
children and with pregnant or lactating women
indication of Phenazopyridine/ Pyridium
used to relieve symptoms such as pain, burning and the sensation of nedding to urinate urgently or frequently caused by irritation of the urinary tract lining
commonly used antibiotics to treat cystitis
TMP-Sulfa/Bactrim,
Quinolones - Ciprofloxin
Amoxicillin/Clavulanate – Augmentin, Nitrofurantoin – Macrodantin
drug that changes urine to distinct dark orange or reddish color
Phenazopyridine/ Pyridium
drug that has been known to permanently discolor contact lenses
Phenazopyridine/ Pyridium…infrequently can cause a yellowish discoloration in the skin or eyes
Metoclopramide/ Reglan should be used with caution in people with
Parkinson’s disease because, as a dopamine antagonist, it may worsen the condition