module one meds Flashcards
salicylates: medication & indication
med: aspirin
indication:
-anti-inflammatory, analgesic, antipyretic, reduction of platelet aggregation
-decreases risk of MI for those with unstable angina or previous MI
salicylates: action & side effects
action:
-irreversible, non-selective inhibitor of COX 1,2
-inhibits prostaglandin production
short-term side effects: renal impairment, GI (bleeding, ulcers, gastritis, dyspepsia)
long-term side effects: metabolic acidosis, resp. alkalosis, dehydration, fluid & electrolyte imbalance, tinnitus
salicylates: considerations
-dose: antipyretic/analgesic 325-650 mg PO, q4
-cardiac: may use 325 mg PO initially in acute event -> 81 mg/day
-avoid alcohol ingestion with med
-admin with food
-observe for bleeding (enteric coating may not prevent GI bleeding)
-don’t admin to kids or adolescents (risk of Reyes Syndrome)
NSAID propionic acid derivative: medication & indication
meds:
-ibuprofen (Motrin, Advil)
-indomethacin
-naproxen
-celecoxib
-ketorolac
indication: fever, analgesic (mild-mod pain), anti-inflammation
NSAID propionic acid derivative: action & side effects
action:
-non-selective inhibitor of COX 1,2 (more selective of COX 1)
-blocks prostaglandin synthesis
-modulates t-cell prod
side effects:
-GI (gastritis, dyspepsia, ulcers, bleeding)
-selective COX 2 inhibitors= known to cause increase risk of thrombotic events (MI, stroke)
NSAID propionic acid derivative: considerations
-admin with food
-avoid alcohol ingestion with med
-cautious with renal impairment (decreasing blood flow -> kidneys)
non-narcotic analgesic antipyretic: medication & action
med: acetaminophen (Tylenol)
action: fever, analgesic
non-narcotic analgesic antipyretic: action & side effects
action:
-decrease prostaglandin synthesis in CNS (no anti-inflammatory effect peripherally)
-anti-prostaglandin activity in hypothalamus -> reduce fever, peripheral vasodilation, anti-inflammatory actions
side effects: liver toxicity in high, regular doses
non-narcotic analgesic antipyretic: consideration
-risk of liver injury
-consume no more than 4000 mg/day (max) -> includes in art in combo prescription prod (Vicodin, Percocet) & OTC prod
-undernourished -> consume no more than 3000 mg/day
-don’t drink alcohol while taking it
-no more than 3 drinks/day -> take no more than 2000 mg/day
-have liver disease -> ask prescriber if med= safe
beta lactam anti-bacterials
-require intact beta lactic ring -> anti-bacterial
-several types of gram +/- can manu beta-lactamases or enzyme that disrupts the med from work -> increased res
beta lactam anti-bacterials: medication & action
meds:
action:
beta lactam anti-bacterials: action & side effects
action: inhibit cell wall synthesis
side effects:
-allergy GI (diarrhea), dyspepsia
-renal impairment -> penicillin accumulates to toxic levels
-suprainfections possible
beta lactam anti-bacterials: considerations
-advise those with penicillin allergy to wear some form of ID to alert emergency healthcare
-report any signs of allergic response (skin rash, itching, hives)
-overdose -> neurologic problems (ex. seizures)
-synergistic with aminoglycoside antibiotics (don’t admin in same IV line)
-take oral pen with full glass H2O 1hr. before meal or 2hrs. after
-pen, v, amoxicillin, & amox/clavulanate may be taken with meals
-measure I/O
-watch for cross-sen with cephalosporins & carbapenems
cephalosporins
with each gen:
-increased activity against gram - org
-increased effectives against org that prod beta-lactamases
cephalosporins: medications & indications
med: cefazolin (prototype)
cephalexin (1st gen), cefoxitin (2nd gen), cefotaxime (3rd gen), cefepime (4th gen), ceftaroline (5th gen)
indications:
-structure & activity= sim to pen
-often for surgical prophylaxis
-gain gram - activity & lose gram + activity as they move from 1st -> 3rd gen
-3rd & 4th gen should be reserved for serious infections (avoid dev of resistant pop of bacteria)
cephalosporins: action & side effects
action: affects cell wall synthesis
side effects:
-risk of increased bleeding with warfarin (interference with vitamin K metabolism)
-allergy GI upset: diarrhea & pseudomembranous colitis immune-mediated hemolytic anemia
-can promote c.diff super-infection
cephalosporins: considerations
-contraindicated if cephalosporin allergy or hx severe allergic reaction to pen
-monitor prothrombin time (parenteral vitamin K -> correct abnormal prothrombin time)
-observe for bleeding (discount if occurs)
-caution w/ hx bleeding disorders & receiving drugs that interferes w/ hemostasis (anticoagulants, thrombolytics, anti-platelet drugs, aspirin/NSAIDs)
-sev -> disulfiram-like reaction if used with alcohol
-take oral ceph w/ food if gastric upset occurs
-refrigerate oral suspensions
-intramuscular injections= frequently painful
-alcohol intolerance & warn them not to drink alcoholic bev
-report any diarrhea
aminoglycosides: meds & indication
med: gentamicin, tobramycin, amikacin
indication: coverage of aerobic gram - bacteria (pseudomonas, Klebsiella, & serratia)
aminoglycosides: action & side effects
action:
-pen cell wall of susceptible bacteria & bind irreversibly to 30S & 50S ribosomal subunits (synthesize proteins)
-IV -> widely distributed
-poorly absorbed systematically from GI tract (act locally w/in tract)
side effects: ototoxic & nephrotoxic -> adjust for renal impairment
aminoglycosides: considerations
-measure peak (30-60 after infusion= done) & trough (just before dose) levels
-watch renal func (BUN/creatinine), doses may be titrated for func
-ototoxicity -> assess dizziness, tinnitus, vertigo, hearing loss
fluoroquinolone: medication & indication
med: ciproflaxcin, levoflaxcin, oxofloxacin
indication: active against aerobic org, most gram - & some gram + (ex. resp, GI, GU infections)
fluoroquinolone: action & side effects
action: inhibit DNA gyrase (bacterial DNA rep)
side effects:
-tendon rupture or tendonitis
-photosen
-candida supra infections (esp. of oropharynx)
-infrequent but serious CNS effects
fluoroquinolone: considerations
-contraindicated in those w/ hx myasthenia gravis
-use w/ caution in renal impairment & age 60+ patients
-don’t take w/ aluminum, iron, calcium, iron, or zinc supplements
-avoid sunlamps & exposure to sun (sunscreen doesn’t protect from photosen reactions)
tetracycline hydrochloride: medications & indications
meds: tetracycline, doycycline, minocycline
indications: chlamydia, UTI, acne, periodontal disease, Rocky Mt Spotted fever
tetracycline hydrochloride: action & side effects
action: bacteriostatic (bind to 30S ribosomal subunit, broad spec)
side effects:
-dev teeth discoloration
-GI distress (nausea, vomiting, cramps, diarrhea, epigastric burning) -photosen, candidiasis
tetracycline hydrochloride: considerations
-take most oral tet on empty stomach + full glass of H2O
-avoid prolonged exposure to sunlight (wear protective clothing, SS)
-allow 2+ hrs btw ingestion & chelators (milk prod, calcium & iron sup, mag-containing lax, & most antacids)
-don’t give to pregnant women or kids below 8 (affect baby teeth, binds to calcium in teeth -> discolored area)
-candidiasis: inform about symp of fungal infection (vag or anal itching, inflammatory lesion of anogenital region, black/furry appearance of tongue) -> advise prescriber
sulfonamides: medications & indications
meds: trimethoprim-sulfamethox (Bactrim)
indication: broad spec (many gram -/+ bacteria), UTI
sulfonamides: action & side effect
actions:
-blocks bac enzymes for synthesis of DNA, RNA, & protein building blocks
-combo of sulfamethoxazole (sulfa drug) + trimethoprim (dihydrofolate reeducates= inhibitor of bac enzyme)= synergistic in activity
side effects:
-hypersen reactions= rash (include Stevens-Johnson syndrome)
-hemolytic anemia + other blood dyscrasias (agranulocytosis, leukopenia, thrombocytopenia, aplastic anemia)
-crystalluria (kidney/bladder stones)
-CNS: headache, psychosis
sulfonamides: considerations
-stay well-hydrated
-first dose: observe for rash, discount use @ first sign of hypersen
-contraindicated for those w/ hx severe hypersen to sulfonamides & chem related drugs (thiazide & loop diuretics, sulfonylurea-type oral hypoglycemics)
-renal impairment -> exercise caution
-consume 8-10 glasses of H2O/day
-avoid prolonged exposure to sunlight, wear protective clothes, SS
-observe for signs of hemolysis (fever, pallor, jaundice)
-therapy= prolonged -> periodic blood cell counts needed
macrolides (erythromycin): medications & indications
meds:
-azithromycin (Zithromax) & clarithvmycin (biaxin) -> less side effects & res, fewer doses
indication: gram + and some gram - (sinusitis, resp, skin, comm-aequired pneumonia, H. pyloria)
-PCN sub if allergic to PCN
-treatment: legionella & chlamydia
macrolides (erythromycin): action & side effects
action: inhibit 50S ribosomal subunit
side effects:
-IV erythromycin, clarithromycin, & azithromcyin= corrosive to veins
-some erythromycin= corrosive to GI tract -> erosive esophagitis
macrolides (erythromycin): considerations
-admin with caution for those taking drugs metabolized by statins & warfarin (erythromycin & clarithromycin= strong inhibitors to cytochrome P450; azithromycin=weaker inhibitor)
-alt to penicillin
-dilute in large quant of fluid, infuse slowly -> large vein
vancomycin: indication
-potentially toxic antibiotic, only for serious infections
-active only against gram +
-can use for those with PCN allergy (ex. MRSA, endocarditis)
-given IV or PO
-PO: bowel infections (ex. c.diff), topical to GI system (not absorbed)
vancomycin: action & side effect
action: affects cell wall synthesis
side effect:
-ototoxicity & dose-related nephrotoxicity
-multiple drug interactions w/ hyperlipidemic drugs, muscle relaxants, ototoxic drugs
-irritate vein -> thrombophlebitis (use large vein, change site often)
-rapid infusion -> “red man syndrome”
vancomycin: considerations
-measure peak (2hr after admin) & trough (30 min before next dose)
-watch renal labs!!
-“red man syndrome” : flushing, rash, pruritus, urticaria, tachycardia, hypotension
-minimize risk: infuse vancomycin slowly over 60 min or time given by pharmacist
metronidazole/Flagyl: indication
target anaerobic org (includes parasites, bacteria, C.diff)
metronidazole/Flagyl: action & side effects
action: prodrug, activated only in anaerobic cells
side effects: darken urine, CNS adverse effects, caution during pregnancy, avoid during lactation
metronidazole/Flagyl: considerations
-drug-drug interaction (always check compatibility)
-admin PO and IV
acyclovir, valacyclovir/valtrex: indication
-active against all herpes viruses (simplex, zoster, cytomegalovirus)
-most strains of CMV= resistant
acyclovir, valacyclovir/valtrex: action & side effects
action: suppress viral DNA synthesis
side effects: nephrotoxic (maintain high hydration -> dilute drug in renal tubules)
acyclovir, valacyclovir/valtrex: considerations
-topical, oral, IV
-herpes simplex -> acyclovir only decreases symptoms
-cleanse affected area with soap & H2O 3x/day, dry thoroughly after each wash
-avoid all sex contact whole lesion=present
-use condom when lesions= absent
adamantanes (amantadine, oseltaminvir/tamiflu): indication
influenza: no longer rec for treatment or prophylaxis for flu A
not effective against flu B
adamantanes (amantadine, oseltaminvir/tamiflu): action
neuraminidase inhibitor
adamantanes (amantadine, oseltaminvir/tamiflu): side effects
few, nausea, & vomiting
adamantanes (amantadine, oseltaminvir/tamiflu): considerations
-must be taken very soon after first flu symptoms (w/in 48 hrs) -> shorten duration of illness
-treatment started w/in 12 hr symptom onset -> symptom duration reduced by more than 3 days
-started w/in 24 hr symptom onset -> symptom duration reduced by less than 2 days
-started w/in 36 hr symptom onset -> symptom duration reduced by 29 hrs
-oseltamivir: reduce symptom sev & incidence of comp (sinusitis, bronchitis)
ganciclovir: indication
-active against all herpes viruses (includes CMV)
-reserved for CMV treatment in immunocomp patients (includes HIV infected & transplant)
ganciclovir: side effects
-excreted unchanged in urine (decrease dose w/ renal impairment)
-granulocytopenia & trombocytopenia= prom adverse effects (monitor blood counts)
-teratogenic & embryo toxic (birth control= in place)
ganciclovir: considerations
poor oral bioavailability= slightly increased by food
