pharm test one

• acetylsalicylic acid
• 1st generation
• ibuprofen
• naproxen
• indomethacin
• ketorolac
• 2nd generation
• celecoxib
• meloxicam

• bleeding/clotting disorder
• peptic ulcer disease
• use of anticoagulants or steroids (risk of bleeding)
• viral disease in children
• liver/kidney disease
• avoid in pregnancy

• history of cardiovascular disease
• liver/kidney disease, seizure disorders

avoid in pregnancy

• toxic additive effect:
• taking ASA with another NSAID
• ASA associated with Reye's in children
• tinnitus in adults
• impairment of renal perfusion
• (risk increases in long-term use)
• peptic ulcers, dyspepsia

• WATCH OUT !! Black Box Warning
• liver disease

don't drink

• when pt takes seizure meds, anticoags
• (increase prothrombin time, slows metabolism of warfarin)

do not exceed 4000 mg in 24 hours

mucomyst

• morphine sulfate (morphine)
• fentanyl
• meperidine
• methadone
• codeine

alcohol + opioid = dead

first pass drug = extensive liver metabolism with oral route availability (oral doses tend to be larger than IM or IV doses to accommodate the first pass metabolism)

• use with MAOI's - increase BP, hyperpyretic coma
• giving with sedative effect drugs - increases sedation
• anticholinergics - used with benedryl will increase sedation

• head injury or any condition where increased ICP could be problematic
• will increase intracranial pressure

reduced doses in elderly or with liver disease

avoid in pregnancy - result may be fetal addiction

• respiratory depression
• sedation
• decreases GI motility
• vomiting
• hypotension
• urinary retention
• euphoria
• seizure
• allergic reactions (causes histamine release - be alert to itching

• do not use for premies
• caution: pt with COPD, asthma, head injury, extremely obese
• very young or very old pt have increased adverse effects
• Meperidine (Demerol) do not use for more than 48 hrs and never in kids
• limit 600 mg/24 hours

• butorphanol (stadol)
• nalbuphine (nubain)

• CNS depressants increase sedation
• dose reduction needed with liver/renal disease
• cardiovascular disease - increase cardiac workload

the type of side effects are the same as commonly observed with opioid analgesics

somnolence, dizzyness, nausea/vomiting are the most common

hypotension within first hour after administration

naloxone (narcan)

interfere with action of opioids by competing with opioid receptors

• dose adjustment needed if there is brain tumor or head injury, seizures, heart disease or a heart rhythm disorder, or a history of durg or alcohol addiction.
• Possible hypersensitivity reactions may occur as well

• works quick
• wears off so additional doses may be needed

• dizzyness
• fainting
• dyspnea
• chest pain
• tachycardia
• dysrhythmias
• seizures

• colchicine
• indomethacine - also an NSAID - really does nothing to relieve uric acid crystals

• colchine should not be used by a person with a known hypersensitivity to the drug or by a pt with serious GI, renal, hepatic, or cardiac disorders
• also pt with blood disorders, should not use colchine

• GI effects most common: N/V/D
• bone marrow depression with long-term therapy
• peripheral neuritis, purpura, myopathy, allopecia, reversible azoospermia

cautious use when pt have renal disorders

• expected = increase in gouty pain which is transient
• most frequent adverse event is skin rash which may result in discontinuation of the drug

most serious is renal failure

• increase uric acid of kidney
• drink 6-8 glasses of h2o per day

prolongs antibiotic effects - penicillin or cephalosporin

Used for anti-inflammatory effects

to prevent inflammation and dilation of intracranial blood vessels = decrease in pain

• ergot alkaloids - ergotamine, ergotamine/caffeine
• serotonin receptor agonists - triptans
• beta-blockers - propranolol
• anticonvulsants - divalproex ( depakote ER)
• tricylics - amitriptyline
• calcium channel blockers - verapamil
• estrogen - gel & patches

• Pregnancy category X ( stimulates uterine contractions)
• peripheral vascular disease
• ateriosclerosis
• heart/liver/kidney disease
• high BP

• SSRIs (prozac, paxil)
• beta blockers
• HIV meds
• erythromycin
• ketoconazole
• tagamet

Ergotism =numbness or tingling in the fingers or toes, chest pain, weakness of the legs, muscle pain in the arms or legs, pain in the chest, changes in heart rate, swelling or itching

• a systemic drug- not just in the head
• causes abortions
• strong vasocontrictor, so = peripheral vascular - makes it worse
• arteriosclerosis/heart/liver/angina

"sulfa" drug - hypersensitivity

• life-threatening serotonin syndrome when combined with MAOIs, SSRIs, SNRIs and triptans
• liver disease = reduce dose
• documented heard disease- don't use
• elderly/peds - don't use

• nausea
• vomiting
• dizzyness
• burning sensation
• numbness of digits
• sinusitis
• tinnitus
• myalgia
• phonophobia
• photophobia
• hypertensive events due to systemic vasoconstriction
• serious cardiac events

• propranolol - beta blocker
• prevention of migraines
• causes hypotension
• divalproex - antiepileptic
• stablize vessels in CNS
• amitriptyline - tricyclic antidepressant
• influences how body uses serotonin/norepinephine
• verapamil - calcium channel blocker
• stablize the vessels - preventive
• estrogen - hormonal agent
• stablize and prevent highs and lows

• caution with renal/liver disease or decreased lung function
• pregnancy X - causes fetal defects/miscarriage
• discontinue several months if conception is planned (either partner)

• stomatitis
• GI upset
• WBC counts
• hair loss
• skin rash/itching
• headache
• drowsiness
• severe toxicity of liver (cirrohosis)
• kidneys (proteinuria)
• bone marrow (WBC/platelets)
• Chemo drug

• avoid in pt with blood, liver or kidney disease
• recent radiation treatment
• uncontrolled diabetes

• rash/inflammed skin (most common, itching is a first sign)
• stomatits
• indigestion
• a metallic taste in your mouth
• renal toxicity
• blood dyscrasia (severe or bloody diarrhea, easy bruising or a nosebleed)
• in rare cases - exposure to sunlight may cause areas of the skin to turn a bluish-gray color

• a form of gold works against inflammation after other agents have failed or with something else
• flushing, dizziness, fainting - have to sit/laydown when administering
• given once a week and than back off once a month

• few DDI known
• typically well tolerated

• pharmacogenetics:
• use cautiously in pts of African descent (development of severe anemia) due to cycle cell anemia
• worsens psoriasis

• nausea and diarrhea, skin rashes or hair changes (bleaching or thinning of hair)
• weakness
• ocular toxicity - retina
• get baseline eye exam to watch eye there after - visual changes - call us
• autoimmune process is affected
• prevents inflammatory process from starting

• hypersensitivity (think "sulpha drug"
• DDI - digoxin, warfarin, liver/kidney disease = reduced doses needed

• nausea/abdominal discomfort
• stomach ulcers
• skin rash
• headache
• photosensitivity = common for sulfa drugs = long sleeves =) sunburn
• discoloration of urine/skin are most common
• less common = reduced WBC/RBC counts

• not to be used with existing CNS disorders
• multiple sclerosis
• myelitis
• optic neuritis
• drug interaction studies have not been conducted
• may reduce the response of the immune system (caution if pt has condition that suppresses the immune system OR when an immune response is desired such as a vaccination and DO NOT USE if there is an active infection)

most common = redness, itching, pain, or swelling at the site of injection

• reverses response of immune system
• "biologic response modifier"
• depressing immune system
• knock out ability of immune system to respond to inflammation

• do not use if pt taking "gold salts"
• antimalarial (plaquenil)
• cytotoxic drugs (rheumatrex)
• because of similar bone marrow and kidney risks
• weakens collagen therefore reduce the dose when surgery is considered/resume after the wound has healed

• rash (itching may be pretreated with antihistamines to decrease)
• if rash is accompanied by fever/joint pain = discontinue
• anorexia
• nausea
• abdominal pain
• loss of the tense of taste
• bone marrow suppression serious kidney disease

• all pts who take penicillamine require regular blood and urine testing for monitoring
• may induce immune-mediated diseases

• innate
• you're born with it

• acquired or adaptive
• you develop it

• trick the body into producing antibodies against a harmless imposter
• then, if the real microbe turns up, the body's defenses are primed to foil infection and disease

not to cure or manage disease but to prevent it

to create rapid but temporary immunity because pt was exposed to something

made up of pooled protein from 100's of people so like giving wrong blood

• prior allergic reaction
• recent or proposed live virus vaccination
• recent or proposed allergy testing (may create false positive)
• pregnancy & lactation (weigh risk vs. benefit)

• local pain/tenderness at the injection site
• urticaria
• angioedema
• anaphylactic reactions, although rare, have been reported-keep epinephrine on hand and observe pt closely after injection

gives passive immunity - so chicken pox vaccine will not work

• stay with pt for 20-30 minutes after given
• any vaccines processed or planned - re-vaccinate or postpone vaccine

• to enhance immune response
• generally to reduce proliferation of cancer cells

• underlying heart/kidney/liver/CNS disease
• pregnancy
• prior hypersensitivity
• "dose limiting conditions"

• rash
• alopecia
• N/V/D
• dry mouth
• "aftertaste"
• flu-like syndrome

hypotension (beware of pts on anti-HTN drugs)

• any time immunosuppressants are used:
• Pt is at risk for infection because their immune system is blocked from working appropriately !!
• (that is what these drugs do)

• pre-existing renal/liver disease
• hypersensitivity
• pregnancy (embryo toxic)/lactation
• presence of known neoplasms (risk to spread the cancer)
• concurrent use of other immunosuppressants

• tremor
• hypertension
• hyperplasia of gums
• renal dysfunction
• diarrhea
• hirsuitism
• acne
• bone marrow suppression

• NSAIDS (aleve, naprosyn)
• many antibiotics, especially aminoglycosides
• many seizure drugs-VERY long list

and pt needs to forget their grapefruit

• concurrent use of allopurinal (gout med)
• ACE inhibitors
• inhibits warfarin action
• history of use of immunosuppressants previously (this is a 2nd line drug)
• pregnancy category D (for don't use)

• Adverse reactions:
• primarily hematologic (leucopenia/thrombocytopenia)
• gastrointestinal (nausea/vomiting)
• skin rashes and alopecia also seen

chronic immunosuppression increases risk of neoplasia & hematologic toxicities

• acute/chronic anti-inflammatory
• anti-immune needs

• infectious disease (especially fungal)
• diabetes
• osteoporosis
• liver or thyroid disease
• psychoses ("roid rage" can occur)

adverse effects: LOTS !!

SHORT TERM:

• moderate doses used
• tapered over 1 to 2 weeks

LONG TERM:

• reserved for severe illnesses
• often uses smaller doses

To reduce potential side effects, the lowest dose of corticosteroid possible, still yielding a positive impact, should be given.

• bone marrow suppression
• GI upset: nausea/vomiting which can be severe
• alopecia
• mucositis
• sterility in males/reproductive toxicity
• hyperuricemia - use allopurinal right away - no lobster/shrimp

• orthostatic hypotension
• sedation
• anticholinergic effects such as dry mouth, urinary retention, constipation, blurred vision

• bone marrow suppression
• gastrointestinal distress (nausea, vomiting and diarrhea)

• weight loss
• insomnia

• sedation
• dry mouth

• adrenal insufficency (hypotension, dehydration, weakness, lethargy, vomiting, diarrhea associated with prolonged use)
• osteoporosis
• hypokalemia
• glucose intolerance
• peptic ulcer disease

• transient flu-like symptoms
• venous irritation at injection site
• renal failure, UTI

• bone marrow suppression
• gastrointestinal distress, such as nausea, vomiting and diarrhea, or ulceration