Pharmacology: Principles & Medications

• Unit 3 focuses on Pharmacology.
• The unit covers Pharmacologic Principles, Accountability and Maintenance, Commonly Used Medications, Perform Inventories, Maintain AF 579, and Prescribing and Dispensing Criteria.

Enabling Learning Objectives

• Drugs on the IDMT formulary can be differentiated by class, mechanism of action, common side effects, and appropriate usage based on patient presentation.
• Medication bioavailability can be applied to different patient scenarios.
• The unit describes how drug receptor interactions occur.
• The effects of drugs on the autonomic nervous system are covered.
• The effects of drugs on different receptor times in the body can be identified.
• Different bacteria types can be differentiated.
• Information can be derived on the accountability, maintenance, and inventory of medications.
• Instructions on how to properly maintain an AF 579 are provided.
• Information can be inferred on the dispensing and prescribing criteria for medications.
• Learn how to apply medication routes and bioavailability to different patient scenarios.

Pharmacology Basics

• Pharmacology consists of the study of substances interacting with living systems through chemical processes.
• This is done especially through binding to regulatory molecules, activating or inhibiting normal body processes.
• Medical Pharmacology is the science of substances preventing, diagnosing, and treating disease.
• Toxicology is a branch of pharmacology, dealing with chemicals' undesirable effects on living systems, from cells to ecosystems.
• All substances can be toxic under certain circumstances.
• Chemicals in botanicals are not different from chemicals in manufactured drugs, except for impurity proportions.
• Any substance is harmful if taken in the wrong dosage.
• "The dose makes the poison" - Paracelsus (1493-1541).

Drug Basics

• A drug is any substance changing biologic function through its chemical actions.
• Drugs can be activators or inhibitors on target biologic molecules termed receptors.
• A drug agonist acts as an activator by binding to and activating a receptor.
• Agonists can be full agonists, partial agonists, or inverse agonists.
• A drug antagonist acts as an inhibitor, binding to a receptor to compete with and prevent binding by other molecules.
• Antagonists may be competitive and reversible or irreversible.
• Receptors control pharmacologic events leading to observed drug effects.
• Most receptors are proteins including regulatory proteins(neurotransmitters, hormones), enzymes, transport proteins (Na+/K+-ATPase), and structural proteins.
• The receptor site must be selective to bind to a particular drug.
• Drugs must have the appropriate size, electrical charge, shape, and atomic composition for chemical interaction with a receptor.

Drug-Receptor Interaction

• Upon binding, the receptor must change its function to alter the biologic system.
• Termination of drug action: -- Weak bonds lead to dissociation of drug from receptor with time.
• Strong, irreversible bonds require destroying the drug-receptor complex through metabolism (e.g., aspirin).
• Drugs must be absorbed into the blood from the administration site and distributed to the target site.
• Drugs cross intestinal walls, capillary walls, and the blood-brain barrier to reach the target site.
• Bioavailability is the amount of drug that reaches the systemic circulation.
• Bioavailability depends on extent of intestinal wall absorption, and first-pass elimination.
• First-pass elimination occurs after the drug enters the bloodstream of the liver, and gets partially metabolized, thus lowers bioavailability.

Drug Administration and Bioavailability

• IV route: 100% bioavailability and the most rapid onset.
• IM/SC: 75 to 100% bioavailability.
• Oral: 5 to 100% bioavailability, but significant first-pass effect.
• Rectal: 30 to 100% bioavailability, less first-pass effect.
• Transdermal: 80 to 100, very slow absorption, no first-pass effect, but prolonged duration of action.
• Inhalation: 5 to 100, rapid onset.
• Two major drug elimination routes exist: -- Liver: clearance via biotransformation of parent drug to metabolites. -- Kidneys: clearance of unchanged drug.
• Half-life is the time required to change the amount of drug in the body by one-half during elimination.

Autonomic Nervous System (ANS)

• The autonomic nervous system is concerned with life-necessary functions performed without conscious thought, such as cardiac output, blood flow, and digestion.
• Composed of two divisions: Parasympathetic (rest and digest) and Sympathetic (fight or flight).
• The parasympathetic nervous system is divided in inhibit (rest and digest) functions.
• Parasympathetic nerve fiber: cholinergic fibers.
• • Neurotransmitter: acetylcholine (ACh).
• • Nerve receptor: cholinergic receptors.
• • Example cholinergic effects: Constrict pupils & bronchioles, defecation, urination, bradycardia, salivation, sweating, lacrimation, etc.
• The sympathetic nervous system stimulates (fight or flight effects).
• • Neurotransmitter: norepinephrine and epinephrine.
• • Nerve fiber & receptor type: adrenergic.
• Adrenergic nerve receptors include α1,α2, β1,β2.
• Example adrenergic effects: Dilate pupils & bronchioles, constrict blood vessels, accelerate the heart, increase sweating, salivation & strength, etc.
• Main function for alpha receptors: -- Alpha-1 (α₁): Arterial and venous vasoconstriction. -- Alpha-2 (α₂): Inhibition of sympathetic tone on vasculature (ie. relaxes arteries and veins).
• Main location and function for beta receptors: -- Beta-1 (β₁):
• -- Heart: increases heart rate and contractility.
• -- Kidney: increases renin. -- Beta-2 (β₂):
• -- Works on smooth muscle & cardiac muscle.
• -- Heart: increases heart rate & contractility.
• -- Lungs: bronchiolar smooth muscle.

Commonly Used Medications

• CNS: central nervous system.
• CV: cardiovascular.
• EENT: ears, eyes, nose, throat.
• GI: gastrointestinal.
• GU: genitourinary.
• Resp: respiratory.
• MSK: musculoskeletal.
• Heme: hematology.
• Includes medications for the eye, skin, renal, metabolic, and generic (trade) medications.

Antihistamines - Pharmacology

• Histamine: Neurotransmitter and mediator of allergic reactions.
• • Active in inflammatory and immune responses.
• Histamine Mechanism of Action: -- CNS: stimulant of sensory nerve endings. -- CV: increases heart rate, vasodilator, increases capillary permeability. -- Resp: smooth muscle bronchoconstriction. -- GI: smooth muscle contraction, powerful stimulant of gastric acid.
• Histamine Receptor locations: -- H₁: found in the endothelium, smooth muscle cells and nerve endings. -- H2: found in gastric parietal cells.
• Examples: diphenhydramine, promethazine, meclizine, loratadine, cetirizine, fexofenadine.
• Clinical Applications: Allergic reactions, motion sickness.
• Mechanism of Action: Block H₁ receptors.
• First-generation antihistamines have strong sedative effects and a higher likelihood to block autonomic receptors. -- Used for allergic reactions and to treat motion sickness. -- Diphenhydramine, promethazine, and meclizine are first-generation drugs.
• Second-generation antihistamines are less sedative because there is less distribution to the CNS.
• • Used for allergic reactions.
• • Loratadine, cetirizine, and fexofenadine are Second generation antihistamines.
• Antihistamine Adverse Effects: -- Excessive Sedation for CNS effects or anticholinergic effects. -- Clinical effectiveness of a second-generation antihistamine may diminish over time, and switching to a drug in the same class may restore clinical effectiveness.
• Azelastine Clinical Application: Seasonal allergic rhinitis, allergic conjunctivitis, vasomotor rhinitis. -- It is a H₁-receptor antagonist, inhibiting histamine actions of the nasal mucosa. -- Adverse Effects: Headaches, somnolence, bitter taste in the GI.
• Olopatadine ​​Clinical Application: Allergic eye symptoms. -- It is a H₁-receptor antagonist that inhibits histamine actions of conjunctival epithelial cells. -- Adverse Effects include headache, stinging/burning eyes, foreign body sensation, dry eyes and pharyngitis.

Gastrointestinal (GI) Drugs

• Ranitidine & Cimetidine are H2 blockers used for gastroesophageal reflux disease and peptic ulcer disease.
• • Blocks H₂ receptors on gastric parietal cells, suppressing basal and meal-stimulated acid secretion (hydrochloric acid), and inhibits 60-70% of 24-hour acid secretion.
• • Adverse Effects (most are rare): Includes CNS malaise & vertigo; Heme pancytopenia; Other anaphylaxis, angioedema.
• Omeprazole & Esomeprazole Clinical Applications: -- Gastroesophageal reflux disease and Peptic ulcer disease. -- Blocks the final common pathway of acid secretion in gastric parietal cells (the proton pump or H+,K+-ATPase), inhibits both fasting & meal-stimulated acid secretion, inhibiting 90-98% of 24-hour acid secretion. -- Adverse Effects: CNS headaches; GI abdominal pain, constipation, diarrhea, nausea, vomiting.
• Bismuth Subsalicylate (e.g. Pepto Bismol) Clinical Applications: Treats nonspecific dyspepsia and acute diarrhea. -- Acts as a mucosal protective agent that coats ulcers and erosions, creating a barrier against acid and pepsin. -- Has antimicrobial effects against H. pylori and binds enterotoxins. -- Adverse Reactions: Causes harmless temporary blackening of tongue and stool.
• Laxatives: -- Bulk-forming laxatives (psyllium & methylcellulose): Indigestible hydrophilic colloids that absorb water, distending the colon, and promoting peristalsis. -- Osmotic laxative (polyethylene glycol or PEG): A balanced isotonic solution containing an inert, nonabsorbable sugar (PEG), increasing stool liquidity. -- Stimulant laxative (bisacodyl): Induces bowel movements through stimulation of the enteric nervous system.

More GI Drugs

• Loperamide treats mild to moderate acute diarrhea. -- It is a nonprescription opioid agonist that does not cross the blood-brain barrier so has no analgesic properties or potential for addiction. -- Should not be used in patients with bloody diarrhea, high fever, or systemic toxicity. -- Adverse Reactions: Constipation, and nausea.
• Antiemetics ("vomiting center"): brainstem neuronal region of lat. medullary reticular formation. -- It stimulates adrenergic, histamine H₁, serotonin 5-HT₃, and neurokinin 1 (NK₁) neural receptors.
• Ondansetron Clinical applications: -- Treats Vagal stimulation (post-op) and chemotherapy-induced emesis. -- Blocks peripheral 5-HT3 receptors on intestinal and spinal nerves. -- Adverse Effects: Headache, dizziness, fatigue, malaise, constipation, diarrhea, and musculoskeletal pain.
• Promethazine is used to relieve nausea and vomiting via the inhibition of dopamine, adrenergic, and H₁ receptors. -- Adverse Effects: Sedation, drowsiness, dizziness, and extrapyramidal effects such as tardive dyskinesia.
• Scopolamine treats motion sickness. -- It is a cholinergic receptor antagonist. -- Adverse Effects: Anticholinergic issues, constipation, epigastric distress and nausea/vomiting (limited if given as a transdermal patch).

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

• They engage the cyclooxygenase(COX) pathway releasing prostaglandins that have a variety of effects on blood vessels, nerve endings, and inflammatory cells in turn affecting antipyretic and analgesic effects.
• Non-selective COX inhibitors include Ibuprofen, diclofenac, indomethacin, naproxen, and piroxicam.
• • Ketorolac is administered via IM or IV.
• COX-2 selective inhibitors include coxibs, celecoxib & meloxicam.
• NSAIDS' anti-inflammatory activity is mediated chiefly through the inhibition of prostaglandin biosynthesis with final elimination by renal excretion.
• COX-1 is found in many tissues, contributing to a variety of physiologic responses.
• COX-2 is found primarily in inflammatory cells and known as coxibs, NSAIDs. -- Selective COX-2 NSAIDs have the same efficacy with less gastrointestinal side effects.
• Only coxib available in the US: celecoxib. -- 10-20x more selective for COX-2.
• NSAID with greater selectivity and preference for COX-2: meloxicam.
• NSAID Adverse Effects: -- (common among all NSAIDS): CNS includes headaches, tinnitus, dizziness; CV: hypertension, edema, rarely MI/CHF; Pulmonary: vasoconstriction; GI: pain, nausea, vomiting, ulcers or bleeding. -- In clinical trials with NSAIDS where 25-50% of subjects have gastritis and 10-20% have peptic ulcers at endoscopy. -- Coxibs (more selective for COX-2 enzyme) decreases peptic ulcers by 75% and ulcer-induced complications by 50%. -- Renal: renal insufficiency, renal failure, hyperkalemia and proteinuria. -- Hepatic: abnormal LFTs. -- Heme: rare thrombocytopenia, neutropenia, easy bleeding or bruising. -- Skin rashes, pruritus.
• IDMTs are limited to prescribing 2400mg ibuprofen daily.
• Aspirin, used as an anti-inflammatory, but at smaller doses (81-325mg) provides anti-platelet effects.
• Aspirin's Clinical Applictions: Decreases incidence of cardiovascular events.
• Aspirin Mechanism of Action: Irreversibly inhibits platelets for 8-10 days.
• Aspirin Adverse reactions entail easy bleeding, bruising, and tinnitus.
• Avoid high doses of Aspirin in patients with G6PD, as easier bleeding may potentially occur.

Skeletal Muscle Relaxants

• Cyclobenzaprine, methocarbamol, tizanidine are all skeletal muscle relaxants used for acute muscle spasms caused by local tissue trauma or muscle strains.
• • These are spasmolytics that impact spasticity (increase in tonic stretch reflexes and flexor muscle spasms with muscle weakness).
• -- Tizanidine acts as an alpha-2 agonist.
• -- Cyclobenzaprine and methocarbamol are centrally acting by inhibiting the muscle stretch reflex, but in a poorly understood fashion.
• --- Tizanidine causes drowsiness, dizziness, asthenia, dry mouth and hepatotoxicity.
• --- Cyclobenzaprine and methocarbamol cause antiadrenergic effects, sedation, confusion, and transient visual hallucinations.

Analgesics

• Acetaminophen is a common Analgesic used in treatment of mild to moderate pain. --Mechanism of Action: Inhibition of prostaglandin synthesis. --Also has Antipyretic properties. --Lacks anti-inflammatory properties. --Dizziness, excitement, disorientation at higher doses. Hepatotoxicity at therapeutic and fatal doses. --IDMTs are limited to prescribing a patient 3000mg acetaminophen daily. -Morphine: A prototypical opioid agonist, that was founded in 1803 that comes from the poppy Papaver somniferum. -- Examples: morphine, acetaminophen/hydrocodone, fentanyl, codeine
  • Clinical Application: Analgesia: severe, constant pain & Acute pulmonary edema associated with left ventricular heart failure -Suppression of cough and Diarrhea Mechanism of action: --- Main opioid receptor: μ (mu)-opioid receptor
• -- Agonists bind to receptors located in brain and spinal cord regions involved in transmission and modulation of pain -- Main clinical effect: analgesia ( Concurrent effects: euphoria, sedation, respiratory depression Adverse Effects: --- CNS: sedation --- Resp: respiratory depression---GI: nausea, vomiting, constipation -- Other: Tolerance: with repeated therapeutic doses there is a gradual loss of effectiveness Physical dependence: defined as characteristic withdrawal when a drug is stopped or an antagonist is administered Addiction IDMTs are limited to prescribing 5 tabs acetaminophen/codeine daily
  Naloxone andNaltrexone, which are Known or suspected opioid-induced respiratory depression reversal examples. Precise mechanism: Competitive antagonism of more than one opioid receptor in the CNS. Adverse Effects and CNS: seizures & CV: cardiac arrest, ventricular fibrillation.

Corticosteroids

Corticosteroids have many metabolic effects on the body. prednisone is the medication but an important clinical effect is their anti-inflammatory and immunosuppressive effects- Clinical Application: Allergic reactions: asthma, contact dermatitis, drug reactions, allergic rhinitis, urticaria & Systemic inflammation and infections: sepsis & Inflammatory conditions of bones/joints: bursitis & Pulmonary diseases: asthma, aspiration pneumonia, lung development in premature babies & Skin diseases: atopic dermatitis & Autoimmune disorders: rheumatoid arthritis Mechanism of Action: ---- Anti-inflammatory Effects: Suppressive effects on several mediators of inflammation Inflammatory pathway: Inhibits phospholipase A2 and reduces expression of COX-2 When directly applied topically to skin: Vasoconstriction Decrease capillary permeability by reducing amount of histamine released by immune cells Contraindications and Cautions: Peptic ulcer (can cause this) Heart disease (hypertension with heart failure) Certain infectious illnesses (varicella and tuberculosis) Psychoses (can cause this) Diabetes (can worsen) Osteoporosis Glaucoma

• For oral or topical formulations: dosage should be as low as possible, for short terms and intermittent administration should be used, when possible. • Adverse Effects include Metabolic risk resulting in Iatrogenic Cushing's Syndrome: Exposure to excess glucocorticoids may lead to a rounded, plethoric face and trunk obesity, muscle wasting, mental disorders, hypertension, osteoporosis, diabetes
• Unusual to see serious side effects when used for less than 2 weeks Impaired wound healing Peptic ulcers Adrenal insufficiency if used for long term and stopped abruptly. Special Considerations: Oral corticosteriods may be given as a “burst” or "taper" Burst: same dosage daily for 5-7 days Example: prednisone 40mg po daily x 5 days Taper: start at higher dose for 3-5 days and slowly decline Example: Day 1-5: 40 mg po daily Day 6-10: 20 mg po daily Day 11-15: 10 mg po daily Day 16-20: 5 mg po daily Topical corticosteroids 1% are low in the percentage of their impact after use. Remarkable efficacy in treatment of inflammatory dermatoses Minimally systematically absorbed (1%) •Examples:
• Low potency: hydrocortisone Medium potency: triamcinolone, desonide high potency: clobetasol Adverse Effects: Metabolic: long-term usage in large amounts may lead to iatrogenic Cushing's syndrome Side effects: "Depressed, shiny, often wrinkled cigarette paper skin secondary to fat atrophy" *Rosacea and erythema *Hypopigmentation • - Skin: atrophic skin thinning with long-term usage & Can cause Rosacea and hypopigmentation fluticasone propionate, mometasone.
• *Examples: Clinical Application- Management of nasal seasonal symptoms and perennial allergic and nonallergic rhinitis
• *Adverse Effects CNS: headaches MSK: pain joints or limbs RESP: chest congestion The various medication categories are cardiac, EENT and respiratory, eye, gynecological, neurological, dermatologic, and miscellaneous.

Cardiac Medications

Blood pressure is maintained by the moment-to-moment regulation of:

• Heart: cardiac output and peripheral vascular resistance
• Kidney: regulates volume of intravascular fluid Types:
• Diuretics: Lower blood pressure by depleting the body of sodium and reducing blood volume.
• Thiazides:
• • Work at the distal convoluted tubule in the kidney
• • Example: hydrochlorothiazide -- Loop diuretics:
• • Work at the Loop of Henle in the kidney
• -The most efficacious available
• -Example: furosemide Side Effects a.) GI: Pancreatitis b.) GU: Polyuria, Renal Failure c.) Heme: Anemia, Leukopenia, Thrombocyopenia d.) Metabolic: Electrolyte abnormalities Reduce pressure by relaxing vascular smooth muscle, dilating vessels and reducing peripheral resistance Includes Calcium Channel Blockers which do the following. a.) Inhibit Calcium Influx into Arterial Smooth Muscle Cells i.) Examples of Medications: a. Verapamil b. Amlodipine c. Nifedipine Nitrates a.) Vascular Relaxation: Mechanism is not fully determined. i.) Example: Nitrous Oxide ii.) Treats Stable Angina Due to Its Rapid Onset Short Duration Common Side Effects
• CV: Ave Ventricular Block, Bradycardia, Heart Failure, Ventricular Fibrillation, Asystole GI: Constipation Agents that Block Production Block or Action of Angiotensin thereby peripheral vascular resistance
• • Mechanism of Action A Renin A) Renin is released from

1. From Low Arterial Pressure
2. Neural Stimulation
3. Reduced Sodium B Acts or Angiotensinogen To Product Angiotensin I C Angiotensin I is Converted by Endothelial Angiotensin converting Enzyme To Angiotensin II a.) 2 Maintains High Vascular Resistance; maintains vasoconstrictor, and Sodium retention by: I) Directly Stimulant Sodium Reabsorption in Proximal Tubule II) Indirectly By Stimulating the Secretion of Aldosterone in the Adrenal Cortex, Which Increases Sodium Reabsorption in the Collecting Duct
   • Medications A) ACE Inhibitors: Angiotensin Converting Enzyme Inhibitors (1) Inhibiting conversions from Angiotensin I to II (a) Examples (i) Lisinopril, Benazepril, Ramipril, B) ARBS- Angiotensin receptor Blocking agents (1) Block receptors for Angiotensin II (2) Examples "a) Losartan, Valsarta, Telimsartan Medication

• a.) Adverse Effects (1) CV- Orthostatic Hypotension (2) EENT- Nasal Congestion (3) Resp- Dry, non-producitve cough (ACE only) Heme- Neutropenia (5) Met- Hyperkalemiaa (6) other- Angioedema, Anaphylaxis Reduce Blood Pressure by Reducing Peripheral Vascular Resistance, Inhibiting Cardiac Function, and Increasing Venous Pooling
• a A) Beta-Blockers (1) Sympathetic Beta-Receptor Antagonists I) Examples- Propranolol, Metoprolol, Atenolol -Common Adverse Effects. (1) CNS: Dizziness, Drowsiness Cv: Bradycardia, Heart Failure c). Heme: Thrombocytopenia (4.) Metabolic Hypoglycemia

EENT and Respiratory Medications

• 1.) Name - carbamide otic - Mechanism is to release hydrogen peroxide and softens wax or called cerumen. Releases due to foaming. Local irritation is negative.

Medication

• • 2.) Mucinex expectorant * Clinical- chest congestion cough
• -Mechanism- increases respiratory tract making it easier to clear sections
  • side affects- Headache dizziness nausea Skin - includes skin rash
    3.) Multiple Preparations Containing Pseudoephedrine or Phenylephrine •URI symptoms: nasal and eustachian tube decongestant •Directly stimulates alpha-adrenergic receptors of respiratory mucosa to produce vasoconstriction •Shrinkage of nasal mucous membranes •Reduction of tissue hyperemia, edema •Reduction in nasal congestion •Severe hypertension or coronary artery disease. •Adverse Reaction: stimulation, anxiety, nervousness, dizziness, headache tremor Cardiovascular
• 4.) Caution- Oxymeterzolime hydrochloride is used with Nasal Congestion with URI. Can use alpha 2. Side affect- caution high tension. Check medical history- systemic absorptions- and be cautious.
• 5.) Cough- Topical Anesthetic action on respiratory stretch receptors. Headache Nausea Constipation diarrhea
• 7* Skin- rash: Soar mouth and throat.

• 8. leukotriene receptor antagonist and receptor.

     Albuterol and levalbuterol with brocal patients

Eye Medication 4.) Name- Polyvinyl Alcohol: treats dry eyes by. creating Mucus Membrane. EENT is mild stinging Blurred Vision".

• 6.) Proparacaine And Tetracrime; a topical Ointment and Eye Procedures- such as foreign Body removal. The Anesthetic Effect
• 7.) Side Affect- Burring redness. Conducitvial, Hermonge S.) Eye Scopolomine hydrobronile- - I ritis- and uventitis- blocks. Achelco-line at cholinergic Receptors.
• 6. Side Affect Blurred- ision a Condujtis- drye Eyes." Gynecological Medications:
• IName: phenazopyridine hydrochloride for Pain with Uti. colors urine red and orange and fabrics and contact.
• Neurological Medications:
• 1.)Hormone Thereapy: multiple oral medication in
• • multiple IM injection & topical medication and with patches. Clinical Application: is not all oral: Injections, or multiple delivery. With Implants. Device is the levonrgestet. Contractions
• And hormone replacement: And also uterus bleeding'
• 2.) Mechanisms- inhibition.
• 3. Anti- anxiety, the treatment- that they are

Used-with the the sedatives. Side effects- dependance- a And Tolerance is also a possibility with these

• Anti-depression- is the main stay treatment. Side effects that are possible- but mostly
• that can lead to more problems.

4. flumazenil reverses that effects of benzodiazepines after Anesthesia and in a suspected overdose situation. mechanism is complete Inhibit Actions of benzodiwzepines on GA but 5.) Name, sumriptan: can be a cluster or migraine or to relieve pain or constricts the and. - dizziness and vertigo side affect. 5.) Ergotanmine and caffeine : are for headaches- to stop more

• •8) Selective : serotonin, reuptake inhibitor. Neurological problems are the use of sedatives. Also used for anxiety: There problems occur after use- side effect. Dermatologic Medications - It is a treat for general peranal warts with badal. Exact mechanism. Is used with all the skin on itching. Permethrin: used for Lile and it works when the nerve paralysis the pest and it burn the skin after this -

Miscellaneous Medications

• Name: ferrous sulfate, used for Iron Deficiency Anemia and to help in the formation of Hemoglobin. Possible problems after the gell, stools is after.
• A.) Levothyroxine Clinical- thyroid and. A synthetic T 4. To help with homrone functions. It's a synthetic that that help. "The A F C AND THE NAME AND DOSAGE AND WHAT YOU GAVE AWAY.

B.) Colcrys- Flairs of out & Pucasities with anti acid product after the 2.) Name * All. And how you all all this

c.) Name poly - And The-Side Affect. It is not always the same • * antibiotics* Bacteria classification is important for: A" morphological' B.) their are 4 shapes- circular/ Spiral / rod/ pleomorphic.

Antibiotics

Gram Stain 1. Bacteria a colorfuls and and are stained to view. The die separates bacteria into Graham Postive and gram negative Main 4 are cocci/ rod. . Antibiotics treat bacterial infections using primarily two mechanisms: -- Bacteriostatic: inhibit bacterial growth. ----Bactericidal: kill bacteria by disrupting bacterial cell wall synthesis. A Basic a structure i) Beta- Lactate ring ; beta Lactam Compounds (1.) Bacteria: Destory Beta Lactamase Hyrcolyisis. Greatest actovity bacteria: (1.). gram postive/ grm negative - cocco (2.) Great. Amoxicillin; with pencilium - gram postive and

Beta lactation I "A", Augmetin: Amoxicillin, and Potisium: a Minor Infection: Pharyngitis Lacks Bioavailability - Pen V B Amox: Better bioavaliabilty- Use-UTI etc. Adverse: Effects * Others Allergic "Skin-Rash; Jont Swelling. , and cross reactions A)" 5 percent all Penicillin derrived: Cephalosporins 1." Similar; Stable: Broader Spectrum. (a.) (1.) All generations Gram Postives * gram negative more extra (a) All generations: Urinary track infection - (9 Side: Effects to the point

Tetracyanlin Has Antibiotics and Analgescs and - they stop. The Anti- infitory . Anti -inflammatory is used to aid the process the end Final elimnation of the renal. System •Only coxib available in the US:

• COX- (celecoxib (10-20x more selective for COX- )

• Selective selectivity and to with CO and

• Antibiotics

• 9.) Name* The antibiotics- they block production and can to many function and.

  -1.) Name Promesatheymine it has side affect is the sedations! - This to many and to block the

• Cholinergic- 1 can block and with a trans Dermal medication

• The topical name. A topical it a steroid; with vasocostriction but long terms.

• ANTIVIRAL AGENTS*

1). Viruses Are the intracellular and dependent is the

• • Anti-viral. must Block or or

    (herpes a 1.)HSV is herpes simple x Side affect: Inhibit, and synthis.

( Side: Affect or head aches* *darrhea. :

AF 579 Form

• The Air Force (AF) Form 579 is to as follows, it Must All form to be to and has.

• (a) A F C AND must the to see and (6) ) Date ( to be to pharmacy 4,) has * to all (1) - the

• (5) with what . (6) the date the the- and signatur .

• In order The Pharmacy be to are A", the the are you be . in C all new and the number and code all the the. for to for - You code and . The is the 250 to be and it not , they . The It Is what The be as