Pharm Exam 3

• 1. Analgesia
• 2. Antipyretic
• 3. Antiinflammatory
• 4. GI Irritation
• 5. Inhibit Platelet Aggregation
• 6. Cardiovascular & Metabolic

• 1. Allergy
• 2. GI Irritation- take with full glass of H2O
• 3. Poisonings- especially in children
• 4. Reye's Syndrome
• 5. Decreased Kidney Function- increases sodium and decreases blood flow to kidney *ELDERLY

• Type 1: Chemical Allergy to salicylates
• Type 2: Hypersensitivity because it blocks COX1&2 pathway and increases leukotrienes which have allergic reaction properties leading to anaphylaxis
• Risk: Must have all 3- Aspirin Allergy, Asthma, Nasal Polyps

• 1. Drugs with added GI irritation- Corticosteroids, Alcohol, NSAIDs
• 2. Warfarin Anticoagulants (Coumadin)
• 3. Probenecid (Gout Drug)
• 4. Low level DDI- Ibuprofen w/ Aspirin

• 1.Rheumatoid Arthritis-treats sx (pain, inflammation) but doesn't stop the progression of the disease.
• 2. Analgesia
• 3. Antipyretic
• 4. TIA (tranisent ischemic attack)- intermittent stroke like sx without long term damages
• 5. MI prevention

• 1. Non-Steroidal Antiinflammatory Drug
• 2. RA, Analgesia, Antipyretic, TIA, MI prevention
• 3. Allergy, GI Irritation, Poisonings (Low doses in children), Reye's Syndrome, Decreased Kidney Function (Elderly)
• 4. Drugs with additive GI Irritation (Corticosteroids, alcohol, other NSAIDs), Warfarin anticoagulants, Probenicid, Ibuporfen (w/ Low dose aspirin)
• 5. Has strong Antiplatelet properties which leads to a lot of GI bleeding. Also discontinue use at least a week before any surgery.

An adverse effect of NSAIDs affecting children with Chicken pox or the Flu. Take child to ER immediately if sx- vomiting, lethargy, sleepy, violent HA, disorientation, violent. It can lead to death.

• 1. Non-steroidal antiinflammatory drug
• 2. Dysmenorrhea (at onset and for first 3 days), analgesic, antipyretic, inflammation
• 3. Kidney dysfunction (Elderly and people on diuretics), Na+ retention, Less GI bleeding the ASA
• 4. Additive GI irritants (corticosteroids, alcohol, NSAIDs), Warfarin anticoagulants, Probenecid, Baby Aspirin
• 5. Take with foor or milk. Precaution in CHF and HTN due to sodium retention.
• 6. Analgesic/Antipyretic- 200-400 mg po q4-6h Max 3.2g/day

• 1. 200-400mg po q4-6h Max 3.2g/day
• 2. 30-60mg IM LD, 15-30mg IV/IM g6h regularly or prn. LIMIT 5 days
• 3. 300 mg po qday
• 4. 1-2 g IV q8h
• 5. 80mg IV q8h

• 1. NSAIDs- Reye's syndrome (Flu/Chickenpox pt), Poisonings even with small doses.
• 2. Tetracyclines -<7
• 3. Fluoroquinolones (Ciprofloxacin) <16

• 1. NSAIDs- Kidney dysfunction and GI Bleeding
• 2. Ketorolac-start with a low dose

• 1. Naproxen- 3rd trimester could prolong pregnancy/labor
• 2. Indomethacin- might close patent ductus arteriosus before birth.
• 3. Leflunomide-must stop 2 years before becomming pregnant (males too) or can take cholestryamine for 11 days.
• 4. Gentamicin-ototoxicity to fetus
• 5. Tobramycin- ototoxicity
• 6. Ciprofloxacin
• 7. Tetracycline- pregnancy and breast feeding

• 1. NSAID
• 2. Inflammation (more potent than ibuprofen), dysmenorrhea, analgesia.
• 3. Avoid in pregnancy (3rd trimester prolongs labor), Kidney dysfunction, Na+ retention, GI Irritation (less than ASA)
• 4. GI Irritants (Coricosteroids, Alcohol, NSAIDs), Warfarin, Probenecid
• 5. Longer acting than ibuprofen.

• 1. NSAIDs
• 2. Gouty Attack, IV-Closes patent ductus arteriosus in neonates.
• 3. More serious than ibuprofen- peptic ulcer, CNS (HA, dizziness), bone marrow depression. Not for use in pregnancy.
• 4. GI irritants, warfarin, probenecid
• 5. A last resort NSAID for pain/fever due to serious side effects. Not to be used in pregnancy so patent ductus arteriosus isn't closed before baby is born. Very potent prostglandin inhibitor.

• 1. NSAID
• 2. First short term NSAID for Pain management
• 3. Peptic ulcer and bleeding if used longer than 5 days.
• 4. GI irritants, Warfarin, Probenecid
• 5. Start with low dose for elderly. More powerful analgesic, less antiinflammatory effects.
• 6. 30-60mg IM LD, 15-30mg IV/IM g6h regularly or prn. LIMIT 5 days

• 1. COX-2 Inhibitor
• 2. Analgesia, Platelet aggregation
• 3. Abdominal pain, diarrhea, dyspepsia, HA, Allergy (sulfonamides), BLACK BOX- increases risk of MI, CV disease, and stroke because when COX-2 pathway is inhibited COX-1 pathway increases (increases platelet).
• 4.
• 5. When to Use a COX-2 Inhibitor- Pts with multiple medical problems; >75, Pts on corticosteroids, Prior GI bleeds. *Better idea to use an NSAID with less COX-1 inhibition for pts with GI problems rather than a COX-2 inhibitor.

Just FYI

• 1. Disease modifying anti-rheumatic drugs (DMARD)
• 2. For the treatment of RA- Reduces joint damage, increases joint function and integrity. Also used for Cancer and disabling psoriasis
• 3. Liver damage, myelosuppression, rare pulmonary toxicity, toxicity
• 4. Leflunomide (Increases liver toxicity)
• 5. Selected first- low cost, efficacy, low adverse effects. Benefit seen in 1-2 months.

• 1. Disease modifying anti-rheumatic drugs (DMARD)
• 2. Treatment of RA
• 3. Diarrhea, rash, reversible alopecia, contraindicated in pregnancy
• 4. NSAID (Ibuprofen), Cholestyramine, Methotrexate (Increases liver toxicity)
• 5. Antiproliferative effect on T-Cells. Category X for pregnancy- Males and females must stop taking it if trying to become pregnant- Can take cholestyramine for 11 days.

• 1. Biological Response Modifiers (BRM are like DMARDs)
• 2. Treats RA (strong antiinflammatory effect)
• 3. Injection site Reaction (erythema, itching, pain, swelling), positive antinuclear bodies, increased infection risk. FDA warning- Risk of fungal infection can lead to death in immunosuppressed individuals.
• 4.
• 5. Very expensive and only available injectable, used only when other RA treatment doesn't work. Prep-powder mixed with bacteriostatic H20- gently swirled to avoid foaming. [Acts as a Tumor necrosis factor (TNF) receptor and TNF is main cytokine responsible for inflammation in RA]

• 1. Gout Drug
• 2. Treats gout by decreasing joint inflammation
• 3. GI-N/V/D, abdominal pain, chronic toxicity.
• 4.
• 5. Use only until gout symptoms are relieved or if GI is upset. Injected directly into the joint.

• 1. Gout drugs
• 2. Treats gout by decreasing inflammation in the joint.
• 3. Less adverse effects than Colchicine- N/V/D, Abd pain.
• 4.
• 5. For short term use only. 1st choice for acute gout attacks.

• 1. Gout drug
• 2. Treatment of Gout by decreasing uric acid production
• 3. Rash, drowsiness, bone marrow depression (sore throat, bleeding), kidney stones.
• 4. Azathioprine and 6-mercaptopurine (Cancer drugs)- will have to adjust the dose
• 5. Used with kidney dysfunction because kidney can't remove uric acid effectively. Acute attacks may occur as crystals break up and begin moving out of joints.
• 6. 300 mg po qday

• 1. Gout drugs
• 2. Treats gout by increasing renal excretion of uric acid (inhibits reabsorption)
• 3. kidney stones, N/V, anorexia, hematuria, HA.
• 4. Many- Aspirin, diuretics
• 5. Need to increase fluid intake and alkalinize the urine. Not for use in impaired kidney function.

• Uric acid metabolism disorder causing crystals to form in joints.
• Obesity, Males, Alcoholism, Heredity, Middle Age

• 1. Antibiotic (Penicillins)
• 2. Mostly Gram + bacteria
• 3. Allergic reaction (most common drug allergy), contact dermatitis, GI distress.
• 4.
• 5. G- original, oral only, must be taken on empty stomach; V(K)- oral not affected by food, no need to be on empty stomach; G(parenteral)- combined with sodium or potassium salts so monitor electrolyte levels.
• Not effective against penicillinase (beta-lactamase) producing organisms.

• 1. Semi-synthetic penicillins
• 2. IV for Penicillin resistant organisms (Gram +)
• 3. No need to know
• 4.
• 5. There are methicillin resistant organisms now.

• 1. Semi-synthetic penicillins
• 2. Oral treatment for penicillin resistant organisms (Gram +)
• 3.
• 4.
• 5. Acid Resistant too so no need to take on empty stomach. For mild to moderate infections.

• 1. Non-penicillinase resistant broad spectrum penicillin
• 2. Broader spectrum, includes Gram - organisms too
• 3. Diarrhea
• 4.
• 5. Short acting so many doses needed. Usually only used when injectable needed for broad spectrum penicillin.
• 6. ampicillin/sulbactam- for resistant broad spectrum tx.

• 1. Non-penicillinase resistant broad spectrum penicillin
• 2. Gram + and -, Oral antibiotic
• 3. Less GI upset (diarrhea)
• 4.
• 5. Longer acting, higher blood levels than ampicillin. Only oral.
• 6. Amoxicillin/potassium clavulanate for penicillin resistant broad spectrum tx.

• 1. Antipseudomonal penicillins
• 2. Pseudomonal effective peniccillin
• 3. Antiplatelet, Hypokalemia, CNS- confusion/lethargy
• 4. Aminoglycosides- incompatible so cannot be mixed and IV must be separated by >1 hour
• 5.
• 6. Piperacillin/tazobactam- for penicillin resistant organisms

• 1.Cephalosporins 1st Generation
• 2. Antibiotic (Gram + but more Gram - than penicillin); commonly used as prophylaxis before surgery.
• 3. Allergy (similar to penicillin), pain and sterile abscesses at injection sites, transient disturbances in hepatic, renal, or hematological function.
• 4.
• 5. Preferred injectable. Less painful IM injection.
• 6. 1-2 g IV q9h

• 1. 1st generation Cephalosporins
• 2. Oral Antibiotic (mostly gram + but some gram - too)
• 3. Allergy (similar to penicillin), diarrhea, transient disturbances in hepatic, renal, and hematological function.
• 4.
• 5. Oral agent

• 1. 2nd Generation Cephalosporin
• 2. Gram +/- infection, Reserved for resistant gram - tx.
• 3. Allergy, pain and abscess at injection site, diarrhea (oral), disturbances in renal, hepatic, hematologic function.
• 4.
• 5. Careful of Kidney Dysfunction

• 1. 3rd Generation Cephalosporins
• 2. Mostly gram - antibiotic, usually reserved for multiple drug resistant HAI strains
• 3. Kidney Dysfunction, allergy, pain and abscess at injection site, hematologic and hepatic disturbances.
• 4.
• 5. Long duration of action. Careful of Kidney dysfunction.

• 1. Platelet dysfunction
• 2. Disulfiram-like reaction - can't have alcohol or you'll get very sick.

• 1. Macrolides/Lincosamides
• 2. Penicillin alternative for allergy
• 3. GI
• 4.
• 5. Can be oral or injectable. Both require special preparation.
• 6. Oral- acid sensitive so special salt forms used so monitor electrolytes. Injectable- lactobionate is pH sensitive so must be mixed with Sterile H20 without preservative and infused with NS or Buffer d5W

• 1. Macrolide/Lincosamides
• 2. Penicillin alternative, also AIDS related infx
• 3. Diarrhea, pseudomembranous colitis (bloody stools), causes neuromuscular blockade
• 4.
• 5. pseudomembranous colitis is caused by a supra infection when clindamycin knocks out normal flora in GI.

• 1. Macrolide/Lincosamides
• 2. For methicillin resistant staph infections (IV)
• 3. Ototoxicity, nephrotoxicity, skin irritation-pain, thromboblitis, tachycardia (if given too fast), Red Man syndrome (if infused too quickly)
• 4.
• 5. Infuse slowly- 1-2 hours or may lead to Red Man syndrome- Low BP bright red face and chest. Must adjust dose in kidney dysfuntion

• 1. Aminoglycosides
• 2. Very broad spectrum antibiotic
• 3. Ototoxicity (vestibular function-balance), nephrotoxicity, neuromuscular blockade (careful of myasthenia gravis), Pregnancy precaution
• 4. Piperacillin (incompatible to mix)
• 5. Must take peak-to find therapeutic blood levels, and troughs- to make sure there is no build up (toxicity). Hearing damage to fetus. Infuse slowly 30-60 min to avoid neuromuscular blockade. Dose must be adjusted for kidney dysfunction.
• 6. 80 mg IV q8h

• 1. Aminoglycosides
• 2. Broad spectrum antibiotic, for Gentamicin resistant organisms.
• 3. Pregnancy precaution, ototoxicity, nephrotoxicity, neuromuscular blockade (infuse slowly 30-60min?)
• 4. Piperacillin
• 5. Adjust dose in kidney dysfunction

• 1. Tetracyclines
• 2. Broad spectrum against a wide range of microorganisms.
• 3. Photosensitivity, suprainfection (Secondary Fungal), GI upset, Allergy, Precaution in Pregnancy and those under 7 yo.
• 4. Antacids and Iron
• 5. Absorption inhibited by food.

• 1. Tetracycline
• 2. Broad spectrum antibiotic
• 3. Photosensitivity, suprainfection (Fungal), Pregnancy and < 7yo.
• 4. Antacids and Iron
• 5. Ok with food. Longer half life, Less excretion by kidneys so good choice for Kidney Dysfunction

• 1. Antibiotic
• 2. Trichomonal Vaginitis treatment
• 3. Dry mouth, metallic taste, nausea, disulfiram reaction (no alcohol), metabolites carcinogenic in rats (prop 65)
• 4.
• 5. Must tell sexual partner to take the drug too
• 5.

• 1. Fluoroquinolones
• 2. Reserved for complicated UTI
• 3. BLACK BOX: risk of tendon rupture or tendonitis especially >60, those on corticosteroids, and transplant recipients. Pregnancy and Breast feeding precaution, careful <16 yo.
• 4. Theophylline (and Caffeine)-bronchodilator, Aluminum and Magnesium antacids, Iron Vitamins and Zinc
• 5. Take with a lot of Fluids

• 1. Sulfonamides
• 2. Topical burns, eye and vaginal infections, Sterilize GI pre-surgery.
• 3. GI and UT disturbances, Hematologic effects, Common allergy
• 4.
• 5. Short acting, Drink plenty of fluids 3L/day

• 1.Sulfonamides. Sulfamethoxazole and Trimethoprim combo.
• 2. UTI, otitis media, PCJ infections
• 3. GI/UT, hematologic, allergy
• 4.
• 5. Dose usually based on trimethoprim component. Drink plenty of Fluids (3L/day)

• 1-2. Urinary tract analgesic
• 3. Turns urine orange, also will stain soft contact lenses
• 4.
• 5. Sx of UTI occur in 1st 3 days so this drug is used early on.

INH, RIF, PZA (EMB if needed) -for 2 months

INH and RIF daily for 4 months

• Initial phase 2 months-INH, RIF, PZA and EMB
• Continuation phase 6 months RIF, PZA, EMB
• Can also uses some Fluoroquinolones

• 1. INH Tb Treatment
• 2. Can be used for prophylaxis tx.
• 3. HA, Vertigo, Peripheral Neuritis (Vit B6 Deficiency in alcoholics), SLE, Hepatits (Rare but serious, >35)
• 4. HIV drugs.
• 5. If HIV + extend treatment from 6 mo to a year. Monitor liver function tests.

• 1. RIF Tb Drug
• 2. TB treatment, also gram -/+ antibacterial
• 3. GI upset, hepatotoxicity, red color
• 4. HIV drugs, Food
• 5. Take on empty stomach

• 1. EMB Tb drug
• 2. For INH resistant Tb
• 3. Optic neuritis, hyperuricemia, pruritis
• 4. HIV drugs, Allopurinol
• 5. Monitor vision

• 1. PZA Tb Treatment
• 2. Usually only taken for 2 months of Tb treatment
• 3. Hyperuricemia, muscle aching, hepatotoxicity.
• 4. Allopurinol, AIDs drugs.
• 5. Contraindications in Liver Disease and Gout. Do not exceed 2g/day to avoid liver toxicity.

• 1. Antifungal
• 2. IV for life threatening systemic fungal infections
• 3. Flu-like, kidney damage
• 4.
• 5. Not for use in renal impairment... must switch to amphotericin lipid base.

• 1. Antifungal
• 2. Systemic fungal infections
• 3. Flu-like sx, Gynecomastia (man boobs), hepatotoxicity
• 4. Antacids, H2 antagonists, proton pump inhibitors - all because it needs an acidic environment to work.
• 5. oral

• 1. Antifungal
• 2. Candida infections of skin, vag, and Intestine, and Thrush
• 3. N/V/D

• 1. Antiviral
• 2. Topical-herpes genitalis, IV-systemic viral infx (usually in immunocompromised), oral- Herpes zoster(shingles)
• 3. IV: Kidney damage, Oral NVD, dizziness, HA
• 4.
• 5. Avoid Kidney damage by increasing hydration and infuse over 1 hour.

• Shingles is a flare up of a latent chicken pox virus.
• Painful rash on nerve track
• Can lead to postherpetic neuralgia- extrem pain after shingles.

• 1. Amphotericin B Desoxycholate- cannot be used in kidney dysfunction must use amphotericin lipid base
• 2. Vancomycin-dose must be adjusted
• 3. Tetracycline
• 4. 2nd and 3rd gen cephalosporins
• 5. Gentamicin
• 6. NSAIDs- decreases function
• 7. Probenecid- isn't effective
• 8. Tobramicin