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What is the primary action of acetylcholinesterase inhibitors in the treatment of Myasthenia Gravis?
What is the primary action of acetylcholinesterase inhibitors in the treatment of Myasthenia Gravis?
What initial intervention is prioritized for acute hypercalcemia?
What initial intervention is prioritized for acute hypercalcemia?
Which symptom is an early indication of Alzheimer's Disease?
Which symptom is an early indication of Alzheimer's Disease?
Which type of medication is used primarily to prevent infection in dermatologic treatment?
Which type of medication is used primarily to prevent infection in dermatologic treatment?
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What is a common contraindication for the use of acetylcholinesterase inhibitors?
What is a common contraindication for the use of acetylcholinesterase inhibitors?
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What is the treatment goal for Alzheimer's Disease drug therapy?
What is the treatment goal for Alzheimer's Disease drug therapy?
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What is a common side effect of using corticosteroids for dermatologic conditions?
What is a common side effect of using corticosteroids for dermatologic conditions?
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Which of the following is an indication for using levothyroxine in hypothyroidism management?
Which of the following is an indication for using levothyroxine in hypothyroidism management?
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What is a common adverse effect of acetylcholinesterase inhibitor drugs?
What is a common adverse effect of acetylcholinesterase inhibitor drugs?
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What mechanism of action do drugs like propylthiouracil and methimazole have in hyperthyroidism treatment?
What mechanism of action do drugs like propylthiouracil and methimazole have in hyperthyroidism treatment?
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For which condition is calcitonin NOT typically used as treatment?
For which condition is calcitonin NOT typically used as treatment?
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Which of these symptoms is commonly associated with hypothyroidism?
Which of these symptoms is commonly associated with hypothyroidism?
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What is the recommended method of administration for neostigmine?
What is the recommended method of administration for neostigmine?
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Which of the following is a primary use of retinoids like isotretinoin?
Which of the following is a primary use of retinoids like isotretinoin?
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What is the recommended action after using topical anti-infective agents on the skin?
What is the recommended action after using topical anti-infective agents on the skin?
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What effect does hyperthyroidism typically have on appetite?
What effect does hyperthyroidism typically have on appetite?
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Which strategy helps manage cardiovascular symptoms of hyperthyroidism?
Which strategy helps manage cardiovascular symptoms of hyperthyroidism?
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Which adverse effect is associated with the use of levothyroxine?
Which adverse effect is associated with the use of levothyroxine?
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What is the primary mechanism of action of desmopressin acetate?
What is the primary mechanism of action of desmopressin acetate?
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Which adverse effect is associated with the use of vitamin D in calcium metabolism treatment?
Which adverse effect is associated with the use of vitamin D in calcium metabolism treatment?
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Which class of drugs is primarily used to prevent bone mass loss in osteoporosis?
Which class of drugs is primarily used to prevent bone mass loss in osteoporosis?
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What condition results from a deficiency of antidiuretic hormone?
What condition results from a deficiency of antidiuretic hormone?
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What should be monitored when prescribing desmopressin acetate due to its black box warning?
What should be monitored when prescribing desmopressin acetate due to its black box warning?
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Which of the following is a characteristic of hypocalcemia?
Which of the following is a characteristic of hypocalcemia?
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What is the primary role of calcitonin in calcium metabolism?
What is the primary role of calcitonin in calcium metabolism?
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Which medication is used for treating acute, severe hypocalcemia?
Which medication is used for treating acute, severe hypocalcemia?
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What initial fluid treatment is necessary for acute hypercalcemia?
What initial fluid treatment is necessary for acute hypercalcemia?
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Which of the following consequences is most likely if acetylcholinesterase inhibitors are used in a patient with asthma?
Which of the following consequences is most likely if acetylcholinesterase inhibitors are used in a patient with asthma?
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What is the primary outcome of corticosteroids binding to drug receptors on target cells?
What is the primary outcome of corticosteroids binding to drug receptors on target cells?
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What is a characteristic symptom of advanced Alzheimer's Disease?
What is a characteristic symptom of advanced Alzheimer's Disease?
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Which of the following conditions is NOT typically treated with corticosteroids?
Which of the following conditions is NOT typically treated with corticosteroids?
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Which drug is most commonly prescribed for the treatment of Myasthenia Gravis?
Which drug is most commonly prescribed for the treatment of Myasthenia Gravis?
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What is a significant adverse effect of corticosteroid treatment relating to physical appearance?
What is a significant adverse effect of corticosteroid treatment relating to physical appearance?
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What must be done when transferring a patient from systemic to inhaled flunisolide?
What must be done when transferring a patient from systemic to inhaled flunisolide?
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What is the primary concern when using calcitonin for treatment?
What is the primary concern when using calcitonin for treatment?
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What is a known adverse effect of acetylcholinesterase inhibitors?
What is a known adverse effect of acetylcholinesterase inhibitors?
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Which of the following types of disorders are corticosteroids NOT used to alleviate?
Which of the following types of disorders are corticosteroids NOT used to alleviate?
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What is the recommended position to be in after administrating certain medications?
What is the recommended position to be in after administrating certain medications?
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In which situation is the use of corticosteroids most critical?
In which situation is the use of corticosteroids most critical?
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Which statement about Alzheimer's Disease is accurate?
Which statement about Alzheimer's Disease is accurate?
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What symptom might indicate an adverse effect following prolonged corticosteroid therapy?
What symptom might indicate an adverse effect following prolonged corticosteroid therapy?
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Corticosteroids are known to inhibit which of the following immune responses?
Corticosteroids are known to inhibit which of the following immune responses?
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What is the primary use of desmopressin acetate?
What is the primary use of desmopressin acetate?
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Which adverse effect is associated with the use of vitamin D supplements?
Which adverse effect is associated with the use of vitamin D supplements?
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Which medication is critical for the treatment of acute, severe hypocalcemia?
Which medication is critical for the treatment of acute, severe hypocalcemia?
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What is a significant risk associated with changes in fluid volume while taking desmopressin acetate?
What is a significant risk associated with changes in fluid volume while taking desmopressin acetate?
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How does alendronate help in the treatment of osteoporosis?
How does alendronate help in the treatment of osteoporosis?
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What characterizes the condition of hypocalcemia?
What characterizes the condition of hypocalcemia?
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What is the mechanism of action of vitamin D in calcium metabolism?
What is the mechanism of action of vitamin D in calcium metabolism?
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Which of the following is a consequence of untreated Diabetes Insipidus?
Which of the following is a consequence of untreated Diabetes Insipidus?
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What is the primary purpose of antiseptics in dermatologic drug therapy?
What is the primary purpose of antiseptics in dermatologic drug therapy?
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Which statement about retinoids like isotretinoin is incorrect?
Which statement about retinoids like isotretinoin is incorrect?
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In the treatment of hyperthyroidism, which medication is known for decreasing the production of thyroid hormones?
In the treatment of hyperthyroidism, which medication is known for decreasing the production of thyroid hormones?
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What is a common adverse effect of the medication levothyroxine?
What is a common adverse effect of the medication levothyroxine?
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Which symptom is commonly associated with hypothyroidism?
Which symptom is commonly associated with hypothyroidism?
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Which type of dermatologic drug is primarily used to lubricate and hydrate the skin?
Which type of dermatologic drug is primarily used to lubricate and hydrate the skin?
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What is a significant contraindication for retinoids such as isotretinoin?
What is a significant contraindication for retinoids such as isotretinoin?
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Which of the following is NOT an application method of dermatologic drugs?
Which of the following is NOT an application method of dermatologic drugs?
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Which drug is commonly used as an adjuvant medication to control symptoms of hyperthyroidism?
Which drug is commonly used as an adjuvant medication to control symptoms of hyperthyroidism?
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Which chronic condition can lead to increased susceptibility to infections?
Which chronic condition can lead to increased susceptibility to infections?
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What is the primary action of donepezil in the treatment of Alzheimer's disease?
What is the primary action of donepezil in the treatment of Alzheimer's disease?
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Which of the following is a common adverse effect of cholinesterase inhibitors?
Which of the following is a common adverse effect of cholinesterase inhibitors?
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What condition is memantine primarily used to treat?
What condition is memantine primarily used to treat?
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Bethanechol chloride is most commonly indicated for which of the following uses?
Bethanechol chloride is most commonly indicated for which of the following uses?
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Which of these is a contraindication for using cholinergic agonists like bethanechol?
Which of these is a contraindication for using cholinergic agonists like bethanechol?
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How does memantine help in the treatment of Alzheimer's disease?
How does memantine help in the treatment of Alzheimer's disease?
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What is the primary characteristic of Parkinson's disease?
What is the primary characteristic of Parkinson's disease?
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In patients with renal failure, which medication should be avoided?
In patients with renal failure, which medication should be avoided?
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What is the primary benefit of occluding the lacrimal duct after administering ophthalmic drugs?
What is the primary benefit of occluding the lacrimal duct after administering ophthalmic drugs?
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What is the most common cause of otitis externa?
What is the most common cause of otitis externa?
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Which medication is the drug of choice for treating acute otitis media?
Which medication is the drug of choice for treating acute otitis media?
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What adverse effect is commonly associated with the use of amoxicillin?
What adverse effect is commonly associated with the use of amoxicillin?
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Which combination drug is most commonly used for acute external otitis media?
Which combination drug is most commonly used for acute external otitis media?
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What is the mechanism of action for ciprofloxacin in treating necrotizing otitis externa?
What is the mechanism of action for ciprofloxacin in treating necrotizing otitis externa?
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What factor can decrease the absorption of ophthalmic drugs during instillation?
What factor can decrease the absorption of ophthalmic drugs during instillation?
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What should be done between administering multiple types of eye drops?
What should be done between administering multiple types of eye drops?
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Study Notes
Corticosteroids
- Hormones produced by the adrenal cortex.
- Affect almost all body organs.
- Maintain homeostasis when secreted normally.
- Disease results from inadequate or excessive secretion.
- Exogenous corticosteroids: Prednisone is a prototype.
- Other drugs include: beclomethasone, betamethasone, budesonide, cortisone, dexamethasone, flunisolide, fluticasone, hydrocortisone, methylprednisolone, prednisolone, triamcinolone.
- Action: bind drug receptors on target cells, increase or decrease protein synthesis.
- Result: decreased inflammatory response (less edema), decreased chemicals causing dilation and tissue irritation, immunosuppression, inhibition of phagocytosis and tissue repair.
- Uses: control symptoms (do not cure disease processes).
- Allergic or hypersensitivity disorders
- Collagen disorders (Lupus)
- Dermatologic disorders (dermatitis)
- Endocrine disorders (adrenocortical insufficiency)
- Gastrointestinal disorders (ulcerative colitis & Crohn's)
- Hematologic disorders (idiopathic thrombocytopenic purpura)
- Hepatic disorders with edema
- Neoplastic disease (leukemia, Hodgkin's lymphoma)
- Neurologic conditions (cerebral edema, spinal cord injury, nausea & vomiting)
- Ophthalmic disorders (optic neuritis)
Other Drugs for Glaucoma
- Prostaglandin analogs: Most widely prescribed glaucoma drugs.
- Prototype: bimatoprost (Latisse, Lumigan).
- Used for open-angle glaucoma and ocular hypertension.
- Action: ocular hypotension.
Beta-adrenergic blockers
- Prototype: timolol maleate.
- Used for chronic open-angle glaucoma, aphakic glaucoma, secondary glaucoma, and for ocular hypertension.
- Action: blocks beta1 & beta2 to reduce intraocular pressure.
Alpha2-adrenergic agonists
- Prototype: brimonidine.
- Used for open-angle glaucoma and ocular hypertension.
- Action: reduces aqueous humor production.
- Use: lowers intraocular pressure.
Cholinergic drugs
- Prototype: pilocarpine.
- Used for chronic simple glaucoma, chronic and acute angle-closure glaucoma.
- Action: stimulates cholinergic receptors inside the eye.
- Use: reduce accommodation to lower intraocular pressure.
- Adverse effects: burning, conjunctival vascular congestion, headache, cardiopulmonary (hypertension, tachycardia, bronchial spasm), GI (nausea and vomiting, diarrhea)
Carbonic anhydrase inhibitors
- Prototype: acetazolamide (oral), brinzolamide, dorzolamide.
- Used for open-angle and secondary glaucoma.
- Action: inhibits carbonic anhydrase, reducing the rate of aqueous humor formation and lowering intraocular pressure.
- Use: open-angle glaucoma.
- Adverse effects: Stevens-Johnson syndrome, agranulocytosis, anemia, metabolic acidosis
Osmotic Drugs
- Prototype: mannitol.
- Temporarily reduces IOP (intraocular pressure) in acute glaucoma attacks and before surgery.
- Used for corneal ulcers and bacterial conjunctivitis.
- Prototype: fluoroquinolone (ciprofloxacin).
Antiviral drugs
- Prototype: trifluridine.
- Used for primary keratoconjunctivitis and recurrent epithelial keratitis.
Antifungal drugs
- Prototype: natamycin.
- Used for fungal blepharitis, conjunctivitis, and keratitis.
Antiallergic drugs
- Prototype: cromolyn sodium.
- Used for vernal keratitis, vernal conjunctivitis, and vernal keratoconjunctivitis.
- Decreases or stops the body's reaction to an allergen.
H1-receptor antagonists
- Prototype: emedastine difumarate.
- Treatment for ocular pruritus.
- Adverse effect: headache in 11% of cases
Corticosteroids
- Prototype: dexamethasone.
- Decreases inflammation after cataract extraction and corneal refractive surgery.
- Used with anti-inflammatory drugs.
Anti-inflammatory drugs
- Prototype: diclofenac.
- Used for reducing inflammation after cataract extraction or corneal refractive surgery.
Immunosuppressants
- Prototype: cyclosporine emulsion.
- Used to increase tear production.
General Guidelines for Ophthalmic Drug Therapy
- Topical administration is common.
- Effective administration essential for therapeutic effects.
- Systemic absorption is decreased by occluding the lacrimal duct.
- Multiple drops require intervals of 5 to 10 minutes.
Otitis Externa (Swimmer's ear)
- Inflammation of the external ear canal.
- Caused by moisture, allergies, or trauma.
- Topical agents are common for high drug concentration in the infected tissue.
- Systemic medications may be required for deep tissue infections, or if immunocompromised.
Otitis Media
- More common in children.
- Bacteria or pathogens enter the middle ear from the nasopharynx or from the tympanic membrane.
- Oral amoxicillin is the typical treatment.
Anti-infective, antiseptic, glucocorticoid, and acidifying agents.
- Combination drug prototype: neomycin - polymyxin B-hydrocortisone.
- Treats acute external otitis media.
- Action: each drug in the combined formula has its own mechanism to inhibit bacterial growth or limit the inflammatory processes.
- Fluoroquinolone prototype: ciprofloxacin, used for necrotizing otitis externa.
- Action: inhibits bacterial growth.
Antibacterial agent
- Prototype: amoxicillin (a penicillin).
- Inhibits cell wall synthesis in sensitive organisms.
- Result: cell death.
- For acute otitis media.
- Adverse effects: include hypersensitivity to drugs, GI effects, and development of superinfections.
Guidelines for Dermatologic Drug Therapy
- Drug selection depends on the condition and factors (acuity, severity, location, area, and method of application).
- Agent choice depends on patient response.
Antimicrobials (topical)
- Includes:
- Bacitracin, benzoyl peroxide, clindamycin, erythromycin, metronidazole, mupirocin, silver sulfadiazine
- Butenafine, ciclopirox, clotrimazole, ketoconazole, nystatin
- Acyclovir
Antiseptics
- Kill or inhibit bacteria, viruses, or fungi.
- Prevent infection.
Corticosteroids
- Topical use decreases inflammation.
Emollients and moisturizers
- Used as lubricants.
Enzymes
- Trypsin
- Debrides wounds
Immunosuppressants
- Pimecrolimus and tacrolimus (both topical).
- Treatment of inflammatory skin conditions (e.g., psoriasis).
Keratolytics
- Used for treating keratin-containing skin conditions.
Retinoids (isotretinoin)
- Suppresses sebum production.
- Used for acne treatment.
- Adverse effects: strictly regulated by FDA due to reproductive and psychiatric risks.
- Common side effects: dryness, arthralgia, hyperlipidemia.
- Contraindication: pregnancy category X (black box warning).
Sunscreens
- Used to protect from UV exposure.
Hyperthyroidism
- Excessive thyroid hormone secretion.
- Causes: Problems with thyroid, or elevated TSH (thyroid stimulating hormone).
- Graves' disease is a common cause.
Hypothyroidism
- Inadequate production of thyroid hormones
- Causes: Thyroiditis or decreased TSH/TRH.
Antidiuretic hormone (ADH)
- Resorbs water into tubules; regulates urine volume.
Diabetes Insipidus
- Associated with posterior pituitary dysfunction.
- Characterized by large urine output.
- Lack of ADH inhibits the kidney's ability to reabsorb water.
Calcium and Bone Metabolism
- Three main hormones are involved:
- Parathyroid hormone (PTH)
- Calcitonin
- Vitamin D
- Hypocalcemia and hypercalcemia are significant.
- Hypocalcemia is characterized by increased calcium resorption and bone loss; conditions include weaken bones and fractures leading to pain and disability.
Vitamin D
- Increases calcium and phosphorus absorption in the GI tract.
- Adverse effect: hypercalcemia.
Bisphosphonates
- Inhibits calcium resorption from bone.
- Prototype: alendronate (Fosamax) - Treats osteoporosis in post-menopausal women and men.
- Adverse effects are limited when taken as ordered.
- Treatment is required upon waking with 6-8 ounces of water, 30 minutes before eating or drinking. Remain upright for at least 30 minutes following administration.
Calcitonin
- Used for hypercalcemia, Paget's disease, and postmenopausal osteoporosis.
Myasthenia Gravis
- Neuromuscular condition characterized by disruptions in neurologic and autoimmune processes
Acetylcholinesterase inhibitors
- Prototype: neostigmine (IV use only) - used as an antidote for certain surgical treatments (tubocurarine, skeletal muscle relaxants).
- More commonly prescribed: pyridostigmine.
- Use: treatment and diagnosis of Myasthenia Gravis.
Alzheimer's Disease
- Most common form of dementia.
- Deficiency in cholinergic function.
- Neurologic conditions including neuritic plaques and neurofibrillary tangles.
- Symptoms may include difficulty remembering new information; disorientation and mood changes; loss of memory, behavior problems and difficulty speaking or swallowing.
Cholinesterase inhibitors
- Prototype: donepezil (Aricept); rivastigmine (Exelon)
- Action: increases acetylcholine in the brain.
- Used to slow neuronal degradation and improves memory.
- Adverse effects include: headache, dizziness, depression, vertigo, and GI disturbances (depending on the individual).
N-methyl-d-aspartate receptor antagonist
- Prototype: memantine (Namenda).
- Action: antagonizes NMDA receptor.
- Slows progression of moderate to severe Alzheimer's disease.
- Contraindication: renal failure.
Urinary Retention
- Affects the bladder, and is related to general anesthesia, diabetes, prostate enlargement, neurologic disorders (sclerosis, Parkinson's), and surgery.
Cholinergic agonist
- Prototype: bethanechol chloride (Urecholine).
- Action: increases urinary and Gl muscle tone.
- Use: acute post-operative urinary retention.
- Adverse effects: heart block, orthostatic hypotension, GI symptoms, and urinary urgency.
- Contraindication: bladder neck surgery.
Dopamine receptor agonists
- Prototype: levodopa-carbidopa (Sinemet), amantadine, pramipexole, ropinirole.
- Action: increases dopamine in the synapse.
- Use: Parkinson's disease and Restless Leg Syndrome.
- Adverse effects: headache, anxiety, hallucinations, drowsiness, cardiac effects.
- Contraindications: individuals with glaucoma, severe hypertension, MAO inhibitors, severe cardiovascular, pulmonary, renal, hepatic or endocrine disorders.
Catechol-O-Methyltransferase Inhibitors
- Prototype: tolcapone.
- Increases dopamine levels in the brain.
Anticholinergics
- Examples: Atropine, benztropine mesylate (Cogentin), scopolamine, and ipratropium bromide.
- Actions: antispasmodic and antisecretory action.
- Used to reduce secondary symptoms of parkinsonism.
- Adverse effects: anticholinergic effects (depending on the individual).
- Contraindications: glaucoma, GI & GU obstruction, and cardiovascular disorders.
Gastrointestinal anticholinergics
Dicyclomine hydrochloride (Bentyl)
- Action: GI smooth muscle relaxant.
- Treatment of irritable bowel syndromes.
- Adverse effects: anticholinergic effects.
- Contraindication: glaucoma, asthma, and GI/GU obstruction.
Urinary antispasmodics
- Prototype: oxybutynin (Ditropan).
- Relaxes smooth muscles.
- Use: bladder instability.
- Adverse effects: anticholinergic effects.
- Contraindications: ulcers and obstructions.
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