Pharm Final New material:

Here is the study guide for the new material for the final. I don’t have time to do a concise version of the old material, but here is a combined word doc of all the previous study guides so it is easily searchable.

pharmstudyguidefull

NewMaterial

New Material:

 

estrogen-progesterone combined hormone therapy

 

  • together there is a lower chance of endometrial cancer
  • Monophasic—fixed ratio of estrogen and progestin that is taken for 21 days
  • Biphasic—supplies 2 different amounts of progestin during the first and second phases of the menstrual cycle
  • Triphasic—dose of estrogen is constant while progestin is progressively increased (three times) for 21 days

 

anthelmintics

  • A class of antiparasitic drugs that expels parasites from the body.
  • Niclosamide (Nicolicide)
    • Use against flatworms.
    • stool sample must be negative for the parasite for three months to be “cured”
    • Action: kills the head (scolex)
    • parasite is digested once killed.
  • Piperazine
    • paralyzes the worm, then it detaches and is excreted.
  • Mebendazole (Vermox)
    • vermacicidial
    • increased absorption w/ fatty food.

estrogen hormone replacement therapy

  • increase synthesis of DNA, and proteins.
  • can cause Na retention and lower cholesterol
  • For estrogen deficiency, osteoporosis prevention and health
  • SE: WEIGHT GAIN, changes in menses pattern
  • gain about 5lbs of weight from the medication.
  • cautions: endometrial cancer with use over 2 years, do not give to breast feeding women, effects liver, clotting(MI, Stroke), bladder stones,
  • contraindications: breast cancer, abnormal vaginal bleeding, Thrombophlebitis, PE, hyperCa, endometriosis
  • smoking can increase cardiac issues and chance of stroke.

antifungals

 

  • Amphotericin B
  • Broad spectrum  

 

      • Cell wall/membrane permeability is disrupted
        • humans have cell membranes…
        • binds -sterols which are also found in the human body (cholesterol) which causes the renal damage.
        • it is very toxic
      • used for SYSTEMIC mycoses that are potentially fatal, admin parenteral: infusion reaction fever and chills, nephrotoxic
      • ADME: can be found up to a year later in the pt body

 

  • Griseofulvin
  • still in the -azole class
  • just for SUPERFICIAL  (skin infections), not systemic
  • inhibits fungal mitosis

 

    • s/e: Insomnia, Rash and headache

 

  • Ketoconazole

 

    • used in less severe fungal reactions (fungistatic)
    • MOA is it inhibits the synthesis of ergosterol which is a part of the fungal cell membrane
      • this also affects the body’s sterols (sex hormones)
    • -conazols are all less toxic

 

  • Mycostatin (Nystatin)

 

    • Candidiasis only
    • It is in the form of a mouth wash
    • alters the permeability of the membrane
    • used for infant thrush often due to the low side effects.

 

Premarin (estrogen)

  • conjugated estrogen
  • from HORSES
  • see estrogen for SE and other info

anti-parasitics

 

  • for malaria:

 

    • Mefloquine
      • No photosensitivity
      • once a week dose
      • can be used w/ kiddos
      • There are serious psychological SE: anxiety, hallucinations
  • for amebiasis
    • Metronidazole (flagyl)
        • for invasive amebiasis, giardiasis, trichomoniasis
        • SE: neurotoxic, Disulfiram reaction, be cautious with anticoagulants, thrombophlebitis, furry tongue?

oral contraceptives (OCPs, BCPs)

  • Newer OCP have less of the hormones and less side effects.
  • Heavier people have a lower % of “coverage” because of the increased body weight
  • inhibit FSH and LH release
  • many SE and increased coagulability, weight gain, cramps, acne or less acne,
  • Can help with anemia by lessening blood loss during periods.

IUDs

  • a T shaped piece with a copper coil that is pressed up against the fundis and prevents pregnancy for about 5 years.

topical glucocorticoids

Ring / Patch

  • NuvaRing
    • insert for 3 wk
    • take out after menses
    • higher risk of clot than PO

 

  • Patches
    • change wkly, three in a box
    • do not put on the breast
    • Higher risk of clot than PO

isotretinoin (Accutane)

  • Anti acne
  • Preg X
  • monitor triglycerides
  • Steven johnson syndrome, Suicide, Necrolysis, severe birth defects.

Estrogen only pills

  • these are for estrogen replacement, secondary for bone health, and vaginal atrophy
  • Estradiol and estrone are natural occurring steroidal estrogens
  • Conjugated estrogen (Premarin)
  • Diethylstilbestrol (DES) is synthetic
  • Transdermal estrogen (Estraderm)
  • Vaginal creams
  • Compounded mixtures

doxycycline (Tetracycline)

 

  • Broad spectrum
  • Inhibit protein synthesis
  • Effective through PO route
  • for ACNE, lyme Dx, H. pylori, Cholera, Rickettsia, cholera
  • Can treat MRSA with Clindamycin, and Bactrim

 

  • chelation occurs when calcium, Iron, and magnesium containing supplements and foods inactivate the tetracycline and cause it to be inactive
    • do not take with meals!
    • one hour before or two hours after meals to avoid chelation
  • S/E: photosensitivity, brown teeth, not ok for mothers pregnant and breastfeeding moms, do not give to kiddos.

 

testosterone

  • schedule II drug
  • useful for osteoporosis to increases the building blocks for bone growth
  • indicated for hypogonadism, androgen deficiency, may reverse ED, delayed male puberty.
  • administration
    • PO, IM, patches, skin gel
  • SE: ab pain, insomnia, gynecomastia, frequent erections, prostate growth, frequent urination
  • monitor

PDE-5 inhibitors

 

  • cialis
  • levitra
  • Viagra

 

    • schedule II drug
    • useful for osteoporosis to increases the building blocks for bone growth
    • indicated for hypogonadism, androgen deficiency, may reverse ED, delayed male puberty.
    • administration
      • PO, IM, patches, skin gel
    • SE: ab pain, insomnia, gynecomastia, frequent erections, prostate growth, frequent urination
    • monitor for vision changes.

ED Drugs (PDE-5 inhibitors)

 

  • Cialis
  • levitra
  • viagra

 

 

5-alpha reductase inhibitors

  • finasteride (Proscar)
    • inhibits conversion of testosterone into androgen DTH resulting in shrinkage of the prostate.
    • Indication: BPH
    • SE: decrease in lebedo and impotence.
    • Women who are pregnant or may become pregnant should not handle this drug. Male changes in genitalia may result.

DDAVP desmopressin

  • Antidiuretic hormones, for DI (deficiency of ADH) or a deficiency of Vasopressin
  • Nasal route, blow nose before administration
  • only works Neurogenic DI not Nephro-
  • so could be used after head injury and surgery
  • can be used for enuresis too which is bed wetting
  • Complications: water intoxication (imbalance of electrolytes and causes drowsiness headache convulsions and coma)
  • cardiac patients are at a high risk for s/s from fluid overload

vasopressin

  • Antidiuretic Hormone
  • for DI from too little ADH and severe vasodilated shock
  • only excrete unbound water
  • alters renal permeability to reabsorb more water.
  • Decreases urine output and increases BP.
  • can cause an MI in a person with a cardiac pathology
  • Monitor BP, HR and ECG in cardiac patients

amyl nitrate

  • For Chest pain
  • cyanide antidote

thyroid labs

    • TRH is released in the hippocampus
    • TSH is released in the pituitary
    • T3 and T4 are released in the thyroid

 

  • each of these stimulate the production of the chemical below. T3 and T4 slow production/release of TRH telling the hippocampus that there is enough T3/4.  

 

  • In hyPERthyroidism there is high T3 and T4 and low levels of TRH and TSH.
  • In hyPOthyroidism there is low T3 T4 and high levels of TRH and TSH.
    • this can be different depending on other factors, but the takeaway is that the T3/4 hormones are low in hypo and high in Hyper.

BPH Drugs

 

  • 5-alpha reductase inhibitors

 

    • finasteride (Proscar)
  • alpha blockers have an effect shrinking the prostate too

levothyroxine

  • this is T4 and gets converted by the body into T3
  • The dose is very patient dependent and there are MANY pill quantities. this also means that a Generic drug which can be plus or minus 20% of the drug, may cause the patient to be getting too much or too little of the drug.
  • Long H life of a week
  • daily dosing
  • takes about a month to get to the therapeutic effects

liothyronine (Cytomel)

 

  • T3

 

    • shorter H life
    • more money
    • faster onset

radiocontrast dye

 

  • antidote: N-acetylcysteine, Na Bicarb, and normal saline

 

pilocarpine

  • for glaucoma
  • Direct acting cholinergic agonist
  • causes meiosis and contraction of ciliary muscles.
  • eye drops 6qd

flumazenil

  • antidote for Benzos (valium, Diazepam)

cycloplegic drugs

 

  • paralyze ciliary muscles
  • SE: Blurry vision, angle-closure glaucoma, Anticholinergic effects

 

  • mydriatics – dilate the pupil, for surgery and examinations
    • Phenylephrine – dilated eye

N-acetylcysteine

 

  • Antidote for Contrast induced Nephropathy, w/ sodium bicarb and NS
  • antidote for CONTRAST DYE!!!
  • Antidote for acetaminophen (TYLENOL)
  • also a mucolytic but this may be less important.

 

  • PO 140mg/kg, then 70mg/kg q4hr
  • Action: Decreases viscosity of mucus to expectorate
  • inhaled through nebulizer
  • DX that need this are COPD and cystic fibrosis
  • Onset > 1 min Peak 5-10 min
    • Bad odor
  • side effects are runny nose, throat and lung irritation, rash and stomatitis

Sodium bicarb

    • is basic and used to maintain the pH balance

 

  • CHECK IV med compatibility, will get viscous like concrete if mixed with incompatible fluids.
  • enhances renal secretion  
  • antidote for radiocontrast dye with N-acetylcysteine

 

 

ranibizumab (Lucentis)

  • angiogenesis inhibitor
  • can improve visual acuity and reduce risk of further impairment
  • SE: inflammation of the eye, seek medical attention if: eye pain, blurry vision, discharge

antioxidants

  • can help prevent Age related macular degeneration
  • reduce cold/cough time?

medroxyprogesterone

  • a progestin
  • regulates ovulation
  • build up the endometrium for the implantation of the egg

ocular decongestants

  • decrease redness and swelling by vasoconstriction
  • only work on symptoms

Depo Provera

  • IM injection contraceptive
  • lasts three months

angiogenesis inhibitor

 

  • ranibizumab (Lucentis)

 

  • can improve visual acuity and reduce risk of further impairment
  • SE: inflammation of the eye, seek medical attention if: eye pain, blurry vision, discharge

passive vs. active immunity

  • passive immunity is through antibodies
  • active immunity is acting against an active pathogen

Floxin Otic

  • fluoroquinolone, for ear infections in this case
  • can irritate the skin
  • DD interactions w/ amiodarone, and quinidine.

Hep A and B vaccines

 

  • IM inactivated virus injection
  • A
  • Children 12 months or older, 2 doses
  • Duration: 10 years Schedule; first shot, needs booster in 6-12 months Contraindicated in patients with bleeding disorders or febrile illness
  • B

 

    • three doses
    • provides 90% protection; duration unknown
    • May produce mild SE Continue schedule even if delay
    • Most have some immunity after 2 doses.

radioactive Iodine therapy I133

  • for hyperthyroidism and thyroid cancer.  
  • emits gamma and beta particles
  • 8 day H life
  • blocks hormone synthesis
  • needs synthroid after treatment for life (hypothyroid for life)
  • destroys the thyroid gland
  • Lugol’s solution – surgery prep, thyrotoxic crisis, it is an antiseptic

when not to administer a vaccine

  • MMR: not in preg, immunocompromised; allergies to neomycin, gelatin, eggs
  • Varivax: not in preg, immunocompromised, allergies to neomycin, gelatin
  • DTaP: fever, pain
  • OPV: VAPP so use IPV
  • Hib: OK
  • Hep B: anaphylaxis to baker’s yeast; Hep A: OK
  • Influ, Pneumococcal, rotavirus, meningococcal

 

what tetanus to administer by age / circumstance

 

  • If the person has tetanus: Airway, antibiotics, td vaccine, tetanus immunoglobulin
  • DTaP < 10 y.o.; Tdap > 11-12 y.o. as booster; Td if pt has hx of seizures
  • DTap – Schedule: 5 doses; first 3 are 2 mo apart, 4th at least 6 mo after 3rd dose, then between ages 4-6 Not recommended after age 7
  • Contraindicated if previous reaction Report serious rxn: high fever, convulsions, screaming or inconsolable crying, shock

 

IPV

  • Route: SQ; inactivated whole virus
  • Schedule: requires several to reach immunity
  • Protective immune response cannot be assured in immunocompromised
  • Contains trace amounts of streptomycin, neomycin, bacitracin

 

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s