Mod 12 Quiz Flashcards
Ointments
-oil or petrolleum based
-highest medication absorption
-create own occlusive film=retains moisture
-shouldnt put on edematous weeping skin or wound (traps more moisture)
Powder
-good for moist areas (skin folds)
Location
Hairy-lotion preparation is best because its water based
Considerations for topical medications
-location
-need for occlusive covering
Topical glucocorticoids
-relief of itching and inflammation
-Vehicle: cream, ointment, gel
-wide avaliability in potency
-are absorbes systemically-OCCLUSIVE DSG CAN INCREASE ABSORPTION 10X MORE)
-Absorption is proportional to both duration of use and surface area
Factors that increase absorption of topical glucocorticoids
thin skin (eye lids, axilla, face, genitallia), inflammed skin
what is the equation that =trouble
High potency + occlusive dsg + large area application + prolonged therapy
Adverse effects of topical glucocorticoids local vs systemic
Local: increased risk for infection, irritation, atrophy of dermis/epidermis, thinning of skin, purpura, striae, acne/hypertrichosis with long term use
Systemic: adrenal suppression
Subsitute for topical glucocorticoids
Topical benadryl cream-similar effects, anti-itch
Glaucoma
leading cause of preventable blindness in the US
-optic nerve damage–> decreased peripheral vision–> loss of central vision
-impedance of flow of aqueous humor increases intraocular pressure (IOP)
Primary Open angle glaucoma
-most common
-progressive optic nerve damage
-IOP increase or normal
-painless
-develops over years
-treatment=decreased IOP
Treatment for open angle glaucoma
Medications: facilitate aqueous humor outflow or reduce production
First line drugs include:
-beta blockers
-alpha 2 adrenergic agonists
-prostaglandin analogs
Goal for open angle glaucoma
reduce IOP=slowed/halt disease progression
Acute closed angle glaucoma
-r/t trauma, displacement/trauma to iris–.covers trabecular meshwork–.aqueous humor can not exit another anterior chamber= rapid rise in IOP
-develops suddenly
-intensely painful
-irreversible loss of vision in 1-2 days
Treatment for closed angle glaucoma
-beta blockers
-short acting miotics
-carbonic anhydrase inhibitors
Beta blockers
-timolol
-Action: reduces productiom of aqueous humor
indications: primarily open angle glaucoma, but can be for acute
Adverse: local stinging, can be absorbed systemically, can cause bronchospasm
Contraindications for beta blockers for glaucoma
-heart failure, bradycardia, cardiogenic shock, AV block
Prostaglandin analogs
Latanoprost
Action: relax ciliary muscle, which facilitates aqueous humor outflow
Indications: open angle glaucoma
-Adverse: Brown staining of iris, can also increase pigmentation of eyelid and eyelashes
Alpha 2 adrenergic agonist
Bromonidine
-Action: reduces production of aqueous humor, and may facilitate outflow, as well as delays optic nerve degeneration, protects retinal neurons from death
Indication: open angle glaucoma
-Adverse effects: dry mouth, burning, FOB sensation, absorbs into soft contacts
CAN CROSS BLOOD BRAIN BARRIER=DROWSINESS, FATIGUE, HYPOTENSION
How long should you wait after using Brimonidine to then place contact lens
-15-20 mins before putting on lens-under dosed b/c absorbed in lens not in eye
Nonadherence
Factors
-assymptomatic condition
-frequent dosing intervals
-life long treatment
-cost
-age related (forgetfulness r/t dementia, providers failure to continue medications)
Important to monitor adherence and understanding of regimen
Monoclonal antibodies (m ABs)
-derived from a human/mouse or rodent/combo
-antigen given to mouse–> antibodies created + tumor cells added= hybridoma
Hybridomas divide without stopping, antibodies are isolated to –> new drug
mABs target specific antigens and activate natural immune response
Omalizumab
Indicated for allergy r/t asthma
-combines with free IgE=decrease ability to bind to mast cells
-decrease mast cell activation=decreased bronchospams + inflammation
Bezlotoxumab
-indicated for those w/ C.diff and high risk for occurence
-binds to C. diff toxin
-no antimicrobial effects so must be given with ABX
Adverse reactions to mABs
enhance immune system–> adverse immune reactions
-anti-drug antibodies produced (ADAs)=inactivation of mAB + dangerous effects
Hypersensitivity reactions (fevers, hemolytic anemias, myalgias)
-anaphylaxis
-CRS (cytokine release storm)
Approach to the treatment of cancer
surgery/radiation/drug therapy/immunotherapy
Role of drug therapy for cancer treatment
-disseminated cancers/mets
-some localized
-adjunct to surgery/radiation
-immunotherapy leverages bodys own defenses
Major classes of drug therapy
-cytotoxic agents (chemo)
-immunomodulating agents
-hormones/hormone antagonists (breast and prostate Ca)
-targeted drugs
Cytotoxic agents cell phase specific drugs vs. cell phase nonspecific drugs
Cell phase specific
-only work during a particular cell phase
-toxic during replication
-resting phase cells not harmed
-drugs has to be present during replication
Cell phase nonspecific drugs
-effective during all phases
-cells do not need to be replicating
-generally still more toxic to replicating cells than those at rest
Growth fraction=
ratio of proliferating cells to resting cells
Cytotoxic drugs are more active against…
cells with a high growth fraction (e.g. lymphoma, hodgkins)
