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PPT 301 Pharmacology Week 12 Book Notes Chapters 34-36

by: Lexie Stenson

PPT 301 Pharmacology Week 12 Book Notes Chapters 34-36 PPT 301

Marketplace > University of North Dakota > Physiology > PPT 301 > PPT 301 Pharmacology Week 12 Book Notes Chapters 34 36
Lexie Stenson
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About this Document

Hello! These are notes from the book on each of the drugs we need to know. Chapters 34-36. Color-coded as usual
Human physiology
James Haselton
Class Notes
pharmacology, pharm, meds, Nursing, memorize, color code, easy, PPT 301, UND, Book, textbook
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This 9 page Class Notes was uploaded by Lexie Stenson on Friday April 8, 2016. The Class Notes belongs to PPT 301 at University of North Dakota taught by James Haselton in Spring 2016. Since its upload, it has received 30 views. For similar materials see Human physiology in Physiology at University of North Dakota.


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Date Created: 04/08/16
Pharmacology Week 12 Chapter 34 •   Penicillin  G   o   Therapeutic  Class:  Antibacterial   o   Pharmacologic  Class:  Cell  wall  inhibitor;  natural  penicillin   o   Actions  and  Uses:   §   Drug  of  choice  against  streptococci,  pneumococci,  and  staphylococci   organisms  that  do  not  produce  penicillinase  and  are  shown  to  be   susceptible  by  C&S  testing   §   Drug  of  choice  for  gonorrhea  and  syphilis   §   Available  as  either  potassium  or  sodium  salt;  there  isn’t  a  difference   therapeutically  between  the  two  salts   §   Only  15-­‐30%  of  an  oral  done  of  penicillin  G  is  absorbed.    Because  of  this   low  absorption,  it  is  often  given  intravenously   o   Administration  Alerts   §   After  parenteral  administration  be  sure  to  observe  for  possible  allergic   reactions  for  at  least  30  minutes,  especially  after  the  first  d   §   Do  not  mix  penicillin  and  aminoglycosides  in  the  same  IV  solution,  give  IV   meds  at  least  one  hour  apart   o   Adverse  Effects   §   Diarrhea,  nausea,  and  vomiting  are  the  most  common   §   Pain  at  injection  site,  superinfections  are  possible   §   Anaphylaxis  is  the  most  serious  adverse  effect   §   Contraindications   •   Hypersensitivity  to  the  drug  –  because  penicillin  G  is  excreted  by   the  kidneys,  the  drug  should  be  used  with  caution  in  patients  with   severe  renal  disease   o   Interactions   §   Drug-­‐Drug:  Penicillin  G  may  decrease  the  effectiveness  of  oral   contraceptives.    Colestipol  taken  with  this  drug  will  decrease  absorption   of  penicillin.    Potassium-­‐sparing  diuretics  may  cause  hyperkalemia  when   administered  with  penicillin  G  potassium   •   Tetracycline   o   Therapeutic  Class:  Antibacterial   o   Pharmacologic  Class:  Tetracycline;  protein  synthesis  inhibitor   o   Actions  and  Uses   §   Affective  against  a  broad  spectrum  of  gram-­‐positive  and  gram-­‐negative   organisms  including  Chlamydia,  Rickettsiae,  and  Mycoplasma.    Use  has   increased  over  the  last  decade  due  to  its  effectiveness  against  H.  Pylori  in   the  treatment  of  peptic  ulcer  disease.    Given  orally,  but  has  a  short  half   life  that  may  require  a  patient  to  take  it  up  to  fourt  imes  per  day.    Topical   and  oral  preps  are  available  for  treating  acne.    Injections  may  cause  local   irritation  and  be  very  painful.   o   Administration  Alerts   §   Give  oral  drug  with  full  glass  of  water  to  decrease  esophageal  and  GI   irritation   §   Administer  antihyperlipidemic  and  tetracycline  1  to  3  hours  apar  t o   Adverse  Effects   §   Tendency  to  affect  vaginal,  oral,  and  intestinal  flora  and  cause   superinfections.    Irritates  the  GI  mucosa  and  may  cause  nausea,  vomiting,   epigastric  burning,  and  diarrhea.   §   Contraindications   •   Drug  should  not  be  used  during  the  second  half  of  pregnancy,  in   children  8  years  or  younger,  or  in  patients  with  severe  renal  or   hepatic  impairment   o   Interactions   §   Drug-­‐Drug:  Milk  products,  iron  supplements,  magnesium-­‐containing   laxatives,  and  antacids  reduce  the  absorption  and  serum  levels  of   tetracyclines   •   Tetracyclines  bind  with  the  lipid-­‐lowering  drugs  colestipol  and   cholestyramine,  thereby  decreasing  the  antibiotic’s  absorption.   •   Also  lowers  the  effectiveness  of  oral  contraceptives   •   Erythromycin   o   Therapeutic  Class:  Antibacterial   o   Pharmacologic  Class:  Macrolide;  protein  synthesis  inhibitor   o   Actions  and  Uses   §   Inactivated  by  stomach  acid  and  is  thus  formulated  as  coated,  acid-­‐ resistant  tablets  or  capsules  that  dissolve  in  the  small  intestin   §   Main  application  is  for  patients  who  don’t  tolerate  penicillins  or  who  may   have  a  penicillin-­‐resistant  infection   §   Effective  against  for  gram-­‐positive  bacteria   §   Preferred  drug  against  Bordetella  pertussis  (whooping  cough),  Legionella   pneumophila  (Legionnaire’s  disease),  M.  pneumoniae,  and   Corynebacterium  diptheriae   o   Administration  Alerts     §   Administer  on  an  empty  stomach  with  full  glass  of  water   §   Do  not  give  with  or  immediately  before  or  after  fruit  juices   o   Adverse  Effects   §   Most  frequent  are  nausea,  abdominal  cramping,  and  vomiting,  although   these  are  rarely  serious  enough  to  cause  discontinuation  of  therapy   §   Hearing  loss,  vertigo,  and  dizziness  may  be  experienced  when  on  high   doses,  particularly  in  older  adults  and  in  those  with  impaired  hepatic  or   renal  excretion   o   Interactions   §   Drug-­‐Drug:  Anesthetics,  azole  antifungals,  and  anticonvulsants  may   interact  to  cause  serum  drug  levels  of  erythromycin  to  rise  and  result  in   toxicity   •   Gentamicin   o   Therapeutic  Class:  Antibacterial   o   Pharmacologic  Class:  Aminoglycoside;  protein  synthesis  inhibitor   o   Actions  and  Uses     §   Usually  prescribed  for  serious  urinary,  respiratory,  nervous,  or  GI   infections  when  less  toxic  antibiotics  are  contraindicated   §   Effective  against  few  gram-­‐positive  bacteria  including  some  strains  of   MRSA   §   Often  used  on  combination  with  other  antibiotics  such  as  penicillins  or   cephalosporins   §   Not  absorbed  by  the  oral  route,  a  topical  formula  is  available  for   infections  of  the  external  eye   o   Administration  Alerts   §   For  IM  administration,  give  deep  into  large  muscle   §   Use  only  IM  and  IV  solutions  that  are  clear  and  colorless  or  slightly   yellow.    Discard  discolored  solutions  or  those  that  contain  particulate   matter   o   Adverse  Effects   §   Rash,  nausea,  vomiting,  and  fatigue  are  the  most  common   §   Resistance  to  Gentamicin  is  increasing,  and  some  cross  resistance  among   aminoglycosides  has  been  reported   §   Black  Box  Warnings   •   Adverse  effects  from  parenteral  gentamicin  may  be  severe  and   include  the  following:   o   Neurotoxicity   o   Neuromuscular  blockade  and  respiratory  paralysis  are   possible   o   Nephrotoxicity  is  possible   o   Interactions   §   Drug-­‐Drug:  risk  of  ototoxicity  increases  if  patient  is  currently  taking   amphotericin  B,  furosemide,  aspirin,  bumetanide,  ethacrynic  acid,   cisplatin,  or  paromomycin   •   Ciprofloxacin   o   Therapeutic  Class:  Antibacterial   o   Pharmacologic  Class:  Fluoroquinolone;  bacterial  DNA  synthesis  inhibitor   o   Actions  and  Uses   §   Most  widely  prescribed  drug  in  its  class.   y  inhibiting  bacterial  DNA   gyrase,  it  affects  bacterial  replication  and  DNA  repair   §   More  effective  against  gram-­‐negative  that  gram-­‐positive  organisms.     Prescribed  for  UTI,  sinusitis,  pneumonia,  skin,  bone,  and  joint  infections,   infectious  diarrhea,  and  serious  eye  infections   o   Administration  Alerts   §   Administer  at  least  4  hours  before  antacids  and  ferrous  sulfates   o   Adverse  Effects   §   Serious  adverse  effects  are  uncommon   §   Nausea,  vomiting,  and  diarrhea  may  occur  in  as  many  as  20%  of  patients,   some  patients  report  phototoxicity,  headache,  and  dizziness   §   Black  Box  Warning   •   Tendinitis  and  tendon  rupture  may  occur  in  patients  of  all  ages.     Risk  is  especially  high  in  patients  older  that  60;  in  kidney,  heart,   and  lung  transplant  recipients;  and  in  those  receiving  concurrent   corticosteroid  therapy   o   Interactions   §   Drug-­‐Drug:  Concurrent  administration  with  warfarin  may  increase   anticoagulant  effects  and  result  in  bleeding   •   Trimethoprim-­‐Sulfamethoxazole   o   Therapeutic  Class:  Antibacterial   o   Pharmacologic  Class:  Sulfonamide;  folic  acid  inhibitor   o   Actions  and  Uses   §   Most  commonly  prescribed  for  UTIs  (aka  Bactrim)   §   Also  approved  for  treatment  of  Pneumocystis  carinii  Pneumonia,  shigella   infections  of  the  small  bowel,  and  for  acute  episodes  ofc  hronic   bronchitis.    Oral  and  IV  preps  are  available   §   Inhibitors  of  the  bacterial  metabolism  of  folic  acid   o   Administration  Alerts   §   Administer  oral  doses  with  a  full  glass  of  water   o   Adverse  Effects   §   Nausea  and  vomiting  are  the  most  common   §   Hypersensitivity  in  the  form  of  skin  rash,  itching,  and  fever   §   Should  be  used  with  caution  in  patients  with  preexisting  kidney  disease,   because  crystalluria,  oliguria,  and  renal  failure  have  been  reported.   §   Photosensitivity  is  often  reported  so  patient  should  avoid  direct  sunlight   during  therapy   o   Interactions   §   Drug-­‐Drug:  May  enhance  the  effects  of  oral  anticoagulants   •   Isoniazid   o   Therapeutic  Class:  Antituberculosis  drug   o   Pharmacologic  Class:  Mycolic  acid  inhibitor   o   Actions  and  Uses   §   First-­‐line  drug  for  the  treatment  of  M.  tuberculosis  because  decades  of   experience  have  shown  it  to  have  a  superior  safety  profile  and  to  be  the   most  effective,  single  drug  for  the  infection   §   Acts  by  inhibiting  the  synthesis  of  mycolic  acids   §   It  is  bacteriocidal  for  actively  growing  organisms  but  bacteriostatic  for   dormant  mycobacteria   §   It  is  selective  for  M.  tuberculosis   o   Administration  Alerts   §   Give  on  an  empty  stomach  1  hour  after  or  2  hours  before  meals   o   Adverse  Effects   §   Numbness  of  hands  and  feet,  rash,  and  fever.    Neurotoxicity  is  a  concern   during  therapy—patients  may  exhibit  paresthesia  of  the  feet  and  hands,   convulsions,  optic  neuritis,  dizziness,  coma,  memory  loss,  and  various   psychoses   §   Black  Box  Warnings   •   Hepatotoxicity  is  a  serious  and  sometimes  fatal  adverse  effect.     However,  very  rare   o   Interactions   §   Drug-­‐Drug:  Aluminum-­‐containing  antacids  should  not  be  administered   concurrently  because  they  can  decrease  the  absorption  of  the  drug   •   Amphotericin  B   o   Therapeutic  Class:  Antifungal  (systemic  type)   o   Pharmacologic  Class:  Polyene   o   Actions  and  Uses   §   Effective  against  most  of  the  fungi  pathogenic  to  humans;  thus  it  is  a   preferred  drug  for  many  systemic  mycoses   §   Prophylactic  antifungal  therapy  for  patients  with  severe   immunosuppression     §   Not  absorbed  in  the  GI  tract  and  is  often  given   through  IV  infusion   o   Administration  Alerts   §   Infuse  slowly  because  cardiovascular  collapse  may  result  if  medication  is   infused  too  rapidly   §   Administer  premedication,  such  as  acetaminophen,  antihistamines,  and   corticosteroids,  to  decrease  the  risk  of  hypersensitivity  reactions   o   Adverse  Effects   §   Adverse  effects  of  this  drug  can  be  frequent  and  serious  including  fever   and  chills,  vomiting,  and  headache  at  the  beginning  of  therapy   o   Interactions   §   Drug-­‐Drug:  Amphotericin  B  reacts  with  many  drugs   •   Fluconazole   o   Therapeutic  Class:  Antifungal   o   Pharmacologic  Class:  Inhibitor  of  fungal  cell  membrane  synthesis;  azole   o   Actions  and  Uses   §   Acts  by  interfering  with  the  synthesis  of  ergosterol,  however  offers   several  advantages  over  other  systemic  antifungals.    It  is  rapidly  and   completely  absorbed  with  given  orally,  and  is  particularly  effective   against  Candida  albicans   §   Major  disadvantage  of  this  drug  is  its  narrow   spectrum  of  activity   o   Administration  Alerts   §   Do  not  mix  IV  with  other  drugs   o   Adverse  Effects   §   Well-­‐tolerated  by  most  patients.       §   Nausea,  vomiting,  and  diarrhea  are  reported  at  high  doses   §   Hepatoxicity  is  rare  with  this  drug   o   Interactions   §   Drug-­‐Drug:  Strong  inhibitor  of  hepatic  CYP  enzymes  and  has  the  potential   to  interact  with  many  drugs   •   Nystatin   o   Therapeutic  Class:  Superficial  antifungal   o   Pharmacologic  Class:  Polyene   o   Actions  and  Uses   §   Binds  to  sterols  in  the  fungal  cell  membrane,  causing  leakage  of   intracellular  contents  as  the  membrane  becomes  weakened   §   Available  in  a  cream,  ointment,  powder,  tablet,  and  lozenge   §   Too  toxic  for  parenteral  administration,  primarily  used  topically  for   candida  infections  of  the  vagina,  skin,  and  mouth   §   Is  not  absorbed  in  the  GI  tract   o   Administration  Alerts   §   Apply  with  swab  to  the  affected  area  in  infants  and  children  because   swishing  is  difficult  or  impossible   §   For  oral  candidiasis  the  drug  should  be  swished  in  the  mouth  for  at  least   2  minutes   o   Adverse  Effects   §   Topically,  produces  few  adverse  effects  other  that  minor  skin  irritation   §   High  incidence  of  contact  dermatitis   §   When  given  PO  it  may  cause  diarrhea,  nausea,  and  vomiting   o   Interactions   §   Drug-­‐Drug:  unknown   •   Chloroquine   o   Therapeutic  Class:  Antimalarial  drug   o   Pharmacologic  Class:  Heme-­‐complexing  agent   o   Action  and  Uses   §   Developed  to  count  the  high  incidence  of  malaria   §   Is  effective  in  treating  the  erthrocytic  stage  but  has  no  effect  on  the   latent  Plasmodium   §   Concentrates  in  the  food  vacuoles  of  Plasmodium  residing  in  red  blood   cells.    Once  in  the  vacuoles  it  is  thought  to  prevent  the  metabolism  of   heme,  which  then  builds  to  toxic  levels  within  the  parasite   §   Can  reduce  the  high  fever  of  patients  in  the  acute  stage  in  less  than  48   hours   §   Also  used  to  prevent  malaria  by  being  administered  2  weeks  before   patient  enters  into  endemic  area  and  continuing  4-­‐6  weeks  after  the   patient  leaves   o   Administration  Alerts   §   Pediatric  dosage  should  be  monitored  closely     §   IM  should  be  injected  into  a  deep  muscle  and  aspirate  prior  to  injecting   the  medication  because  of  its  irritating  effects  to  the  tissues   o   Adverse  Effects   §   Few  serious  adverse  effects  at  low  to  moderate  doses   §   Nausea  and  diarrhea  may  occur   §   At  higher  doses,  CNS  and  cardiovascular  toxicity  may  be  observed  –   symptoms  include  confusion,  convulsions,  reduced  reflexes,  hypotension,   and  dysrhythmias   o   Interactions   §   Drug-­‐Drug:  antacids  and  laxatives  containing  aluminum  and  magnesium   can  decrease  chloroquine  absorption  and  must  not  be  given  within  4   hours  of  each  other.    May  also  interfere  with  rabies  vaccine   •   Metronidazole   o   Therapeutic  Class:  Anti-­‐infective,  antiprotozoan   o   Pharmacologic  Class:  Drug  that  disrupts  nucleic  acid  synthesis   o   Actions  and  Uses   §   Affective  against  both  the  intestinal  and  hepatic  stages  of  the  amebiasis   §   Preferred  therapy  for  giardiasis  and  trichomoniasis   §   Antibiotic  activity  against  anaerobic  bacteria  and  thus  is  used  to  treat  a   number  of  respiratory,  bone,  skin,  and  CNS  infections   o   Administration  Alerts   §   Extended-­‐release  form  must  be  swallowed  whole  and  taken  on  an  empty   stomach   §   Contraindicated  during  first  trimester  of  pregnancy   o   Adverse  Effects   §   Anorexia,  nausea,  diarrhea,  dizziness,  and  headache.       §   Black  box  warning   •   Drug  is  a  carcinogen  in  lab  animals  and  should  be  used  only  for   approved  indications   o   Interactions   §   Drug-­‐Drug:  interacts  with  oral  anticoagulants  to  potentiate   hypoprothrombinemia   •   Mebendazole   o   Therapeutic  Class:  Drug  for  worm  infections   o   Pharmacologic  Class:  Anthelminthic   o   Actions  and  Uses   §   Most  widely  prescribed  anthelminthic  in  the  U.S.       §   Used  to  treat  a  variety  of  infections  including  roundworm  and  pinworm.   §   It  is  a  broad  spectrum  drug  so  it  is  useful  in  mixed  helminth  infection  s §   Effective  against  both  adult  and  larval  stages  of  said  parasites   §   Very  little  of  the  drug  is  absorbed  systemically  so  most  remains  int  he   intestines  where  it  kills  the  pathogens   o   Administration  Alerts   §   Drug  is  most  effective  when  chewed  and  eaten  with  a  fatty  meal   o   Adverse  Effects   §   Does  not  generally  cause  serious  systemic  side  effects.   §   As  the  worms  die,  some  abdominal  pain,  distension,  and  diarrhea  may   occur   o   Interactions   §   Drug-­‐Drug:  Carbamazepine  and  phenytoin  can  increase  the  metabolism   of  the  drug   •   Zidovudine   o   Therapeutic  Class:  Antiretroviral   o   Pharmacologic  Class:  Nucleoside  reverse  transcriptase  inhibitor  (NRTI)   o   Actions  and  Uses   §   As  the  reverse  transcriptase  enzyme  thymidine  begins  to  synthesize  viral   DNA,  it  mistakenly  uses  zidovudine  as  one  of  the  nucleosides,  thus   creating  a  defective  DNA  strand   §   Used  in  combination  with  other  antiretrovirals  for  symptomatic  and   asymptomatic  patients  whoa  re  infected  with  HIV  as  well  as  for   postexposure  prophylaxis  in  health  care  workers  who  have  been  exposed   to  HIV   §   Resistant  HIV  strands  are  common   o   Administration  Alerts   §   Administer  on  an  empty  stomach,  with  water  only   §   Avoid  administering  with  fruit  juice   o   Adverse  Effects   §   Fatigue,  generalized  weakness,  anorexia,  headaches,  nausea,  and   diarrhea   §   Black  Box  warning   •   Rare  cases  of  fatal  lactic  acidosis  with  hepatomegaly  and  steatosis   o   Interactions   §   Drug-­‐Drug:  Interacts  with  many  drugs.   •   Efavirenz   o   Therapeutic  Class:  Antiretroviral   o   Pharmacologic  Class:  Nonnucleoside  reverse  transcriptase  inhibitor  (NNRTI)   o   Actions  and  Uses   §   Given  PO  in  combination  with  other  antiretrovirals  in  the  treatment  of   HIV  infection   §   Drug  acts  by  inhibiting  reverse  transcriptase   §   Has  the  advantage  of  one-­‐daily  dosing  and  penetration  into  cerebrospinal   fluid   §   Preferred  drug  for  the  initial  therapy  of  HIV  infection   o   Administration  Alerts   §   Administer  on  an  empty  stomach   §   Administer  at  bed  time  to  limit  adverse  CNS  effects   o   Adverse  Effects   §   Sleeping  disorders,  nightmares,  dizziness,  reduced  ability  to  concentrate,   and  delusions   §   Symptoms  gradually  go  away  after  3-­‐4  weeks  of  therapy   §   Rash  is  common  and  should  be  monitored   o   Interactions   §   Drug-­‐Drug:  Patients  who  are  receiving  antiepileptic  medications   metabolized  by  the  liver  may  require  periodic  monitoring  of  plasma  levels   because  efavirenz  may  increase  the  incidence  of  seizures   •   Lopinavir  with  Ritonavir   o   Therapeutic  Class:  Antiretroviral   o   Pharmacologic  Class:  Protease  inhibitor   o   Actions  and  Uses   §   Lopinavir  is  the  active  component  of  the  combination   §   The  small  amount  of  ritonavir  inhibits  the   hepatic  breakdown  of  lopinavir,   thus  permitting  serum  levels  of  lopinavir  to  increase  by  more  than  100 -­‐ fold   o   Administration  Alerts   §   The  oral  solution  form  should  be  taken  with  food  to  enhance  absorption;   tablets  may  be  taken  with  or  without  food   o   Adverse  Effects   §   Most  frequent  problem  reported  is  diarrhea   §   Head  ache  and  GI  related  effects  are  common  including  nausea,  vomiting,   dyspepsia,  and  abdominal  pain   o   Interactions   §   Drug-­‐Drug:  Lopinavir  is  extensively  metabolized  by  hepatic  enzymes,  and   drugs  that  undergo  hepatic  metabolism  may  interact  with  this  drug   •   Acyclovir   o   Therapeutic  Class:  Antiviral  for  herpesviruses   o   Pharmacologic  Class:  Nucleoside  analog   o   Actions  and  Uses   §   Drug  of  choice  for  treatment  of  herpesviruses   §   Most  effective  against  HSV-­‐1  and  HSV-­‐2,  and  is  effective  only  at  high   doses  against  CMV  and  varicella  zoster   §   Prevents  viral  DNA  synthesis   o   Administration  Alerts   §   When  given  IV,  the  drug  may  cause  painful  inflammation  of  vessels  at  the   site  of  infusion   §   Administer  around  the  clock   §   Administer  with  food   o   Adverse  Effects   §   Few  adverse  effects  when  given  topically  or  orally   §   Nephrotoxicity  and  neurotoxicity  are  possible  when  medication  is  given   IV   o   Interactions   §   Drug-­‐Drug:  concurrent  use  of  acyclovir  with  nephrotoxic  agents  should  be   avoided  


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