Medication Therapy: Fluid Therapy, Antibiotics & More

Fluid therapy TBW Total Body Wáter Depends on age, sex Water consumption Infants have the highest proportion of water (70-80%) Ppl over 60y.o. have 50% water in the body Water fluids Intracellular fluid – 2/3 of...

Fluid therapy TBW Total Body Wáter Depends on age, sex Water consumption Infants have the highest proportion of water (70-80%) Ppl over 60y.o. have 50% water in the body Water fluids Intracellular fluid – 2/3 of total body fluid. Extracellular fluid – 1/3 of total; body fluid. It’s a transport system that carries oxygen and nutrients and waste products from body cells. extracellul ar interstital fluid intravascular fluid Hypotonic solution (NaCl 0.45%) has low concentration of nutrients in the blood (low osmotic pressure) Isotonic solution (NaCl 0.9%) Hypertonic solution (NaCl 3%) The concentration of the solution is so high that the cellar water leaves the cell to stabilize the water concentration around the cell. Due to that the cell wrinkles Diffusion Form of passive fluid transportation. Solutes move from area of higher concentration to area of lower concentration Active transport When solutes moves from big concentration area to lower concentration area. Requires energy supplied by adenosine triphosphate (ATP) Osmosis Interstitial fluid Liquid that is contained in intracellular and pericellular Интерстициальная жидкость spaces of tissues Emergency medications A vasopressor A drug that constricts blood vessels and raises blood pressure Adrenaline Is primary drug for allergic reaction. 0,5mg epipen To a person in shock 1-3ml IV Amiodarone Treats atrial and ventricular arrhythmias Causes hypotension 300mg i.v. Not used after non-shockable ventricle fibrilation Atropine Not recommended for cardiac arrest Bicarbonate of soda (sodium) Not routinely given during CPR. Asphyctic cardiac arrest, asidosis and hyperkalemia, poisoning by tricyclic antidepressants Pain medications Nociceptive pain Nociceptive – due to tumor, inflammation, osteoarthritis Neuropathic pain Neuropathic – tissue damage, CNS compression Idiopathic pain Idiopathic – doesn’t indicate nociception or sensory damage Inflammatory response Vasodilation (расширение сосудов), increased vascular (воспалительная реакция) permeability (повышение проницаемости сосудов), accumulation of inflammatory cells in the inflammatory colony Analgesics and antipyretics Paracetamol NSAID’s nonsteroidal anti- Analgetics that relieve pain, fever, inflammation inflammatory drugs Treat mild and moderate tissue pain (Ibuprofen, Ketoprofen) DON’T help to treat idiopathic pain and not very effective for neuropathic pain Absorbed by the liver and excreted by the kidneys  Reduce the effectiveness of beta-blockers Can’t be given to asthmatics Salicylates - Provides relief (headache, dental pain, joint pain) (Aspirin) - Not effective for visceral pain (pain in organs and smooth muscle) Lethal dose 10-30g Not recommended for asthmatics and hemophilia patients Opioids Mild opioids (codeine) Moderate opioids (Buprenorphine) Strong opioids – Oxycodone For people over 12 y.o. Anesthetics Antibiotic medications Bactericidal antibiotics Kill bacteria directly. Includes: antibiotics, beta-lactams, antiseptics Polymyxiin B injures the plasma membrane allowing their contents to leak out. Target cell wall of bacteria. Bacteriostatic antibiotics Stop bacteria from growing, Inhibit the division of bacteria. Includes: tetracyclines, macrolides, aminoglycosides Beta-lactams (Penicilin, Antibiotics that inhibit (stop) cell wall synthesis of Cephlosporins) bacteria Penicillin most commonly used antimicrobial agent in hospital outpatient. Penicillins are bactericidal. They kill bacteria by activating enzymes that destroy the bacterial cell wall. Some organisms produce beta -lactamase, an enzyme that inactivates penicillins. This effect can be blocked by adding a beta-lactamase inhibitor (clavulanic acid, sulbactam or tazobactam) to the penicillin Beta-lactamase inhibitors Block resistance to antimicrobial drugs Includes: clavulanic acid, sulbactam, tazobactam Beta-lactams sensitive Benzylpenicillin – treats hospital-acquired infections (pneumonia, meningitis, sepsis, syphilis). Parenteral administration V-penicillin, V-pen administered before food or 2h after since food decreases absorption. The main antibiotic in outpatient care for upper respiratory tract Dicloxacillin, Diclocil used only for the treatment of staphylococcus aureus infections Cephalosporins used to treat urinary tract infection, otitis, sinusitis. Well tolerated Extended-spectrum Semi-synthetic penicillin. (Amoxicilin) Have a wider spectrum of activity than natural penicillins. Strongly effective against gram-negative bacterial infections1 Amoxicillin is the second most important antimicrobial agent in outpatient care, especially for infants. More adverse effects than narrow-spectrum antimicrobial agents Narrow spectrum drugs is affective against a few bacteria, against Cephalosporins Well tolerated drugs. Bb used to treat urinary tract 1 Их капсула защищает от лейкоцитов (лейкоцитов) и не позволяет им поглощать бактерии, которые естественным образом устойчивы к определенным антибиотикам. К ним относятся: Бруцеллез, kошачьих царапин, xолера, коклюш, инфекции кишечной палочки, инфекции, вызванные гемофильной палочкой (Haemophilus influenzae), чума, сальмонелла, брюшной тиф  infection, otitis, sinusitis 1st generation (Cefalexin, cefadroxil) Cefalexin is well tolerated & used in respiratory tract infections. Acute urinary infections, skin and respiratory infections 2nd generation (Cefaclor, Cefuroxim) Cefuroxime is used against sepsis, pneumonia 3rd generation Effective gram-negative2 bacteria Metronidazole Bacteriostatic drug. Disrupt bacterial DNA structure Used to treat gynaecological and oral infections. Must avoid alcohol consumption Tetracyclines (doxycycline) Inhibit (stop) protein synthesis. AREN’T used for children under 8y.o. and pregnant due to side effect for bones and teeth. Adverse effects: makes skin sensitive to UV light, cause permamnt damage to teeth and change their colour Macrolides The macrolides are bacteriostatic antibiotics with a broad spectrum of activity against many gram-positive bacteria. Suitable for penicillin allergies. Suitable during pregnancy Antifungal (antimycotics) drugs Used for yeast and filamentous fungal infections. Производные перозазола взаимодействуют со многими различными лекарствами из-за метаболизма фермента CYP. Antiviral drugs For HIV, influenza, herpes Antiparasitic drugs (protozoal) Antiprotozoal agents, which treat protozoas. These Mefloquine, Chloroquine, Proguanil include antimalarial drugs. Antihelminthic agents, which treat infections that result from parasitic worms 2 cause infections including pneumonia, bloodstream infections, wound or surgical site infections, and meningitis in healthcare settings  Cardiovascular drugs Types of drugs to improve Improving prognosis cardiovascular function: - ACE inhibitors - Antianginal - ATR inhibitors - Antihypertensive - beta-blockers (deacrese heart rate) - Diuretics - aldosterone antagonist - Antilipemic Relieving symptoms - diuretics - digoxin - nitrates Cardiovascular diseases Decreased vascular elasticity, reduced oxygen supply to heart muscle, stiffening of the heart muscle Indication for medication: artery diseases, hypertension, coronary artery disease, type II diabetes, heart failure Antihypertension drugs  Diuretics, beta-blockers, calcium channel blockers, RAA system drugs  A combination of two medicines lowers BP more than double dosage of one drug  Treatment of hypertension increases salt and fluid secretion, reduces sympathetic nervous activity, reduces circulatory resistance Diuretics - removes sodium and water from the body reducing the amount of circulating blood - decrease heartbeat - the only way to manage fluid retention and treat congestive symptoms - it’s necessary to monitor electrocyte and renal function. - spironolactone the only diuretic that improves of severe impairment Suitable as BP drug for older people, diabetics and patients with swelling. Beta-blockers Reduce the activity of sympathetic nervous system. They block adrenaline and noradrenaline effect on the heart. Lower BP Selective beta-blockers affect primarily beta1 receptor in the heart, while non-selective affect the function of beta2 receptor. Reduce bronchus so are not recommended for asthmatics. Sudden stop using them can cause quick rise of the BP RAA-system drugs ACE (angiotensin-converting enzyme) inhibitors, lower BP (Enalpril, kaptopril, ramipril) by relaxing blood vessels. Reduce organ complications, primary medicine to kidney disease and diabetics Prohibited to use during pregnancy. Adverse effect: cough Calcium channel blockers (ССВ) Extend blood vessels and reduce resistance of the circulation. Fits for elderly ppl and those who can’t stand beta-blockersю CCB of cardiac effect (verapamil) weaken construction power of the heart and affect heart rhythm Coronary artery disease CAD happens when coronary arteries struggle to supply the heart with enough blood, oxygen and nutrients. Narrowing of arteries is caused by high cholesterol or plaques.  Medications Anti-ischemic drug (nitrates, beta-blockers, calcium channel blockers) securing oxygenation of the heart, delating coronary arteries Antihypertensive drugs (ACE inhibitors) Antithrombotic drug (acetyl salicyl acid, clopidogrel, heparin) prevention of infraction Hyperlipidemic therapy reduce lipid accumulation of blood vessels Statins lipid-lowering meds, lower LDL cholesterol level (low-density lipoprotein). atorvastatin (Lipitor), fluvastatin (Lescol), pravastatin (Lipostat), rosuvastatin (Crestor), simvastatin (Zocor) ACE (angiotensin-converting Dilate arteries and lower BP inhibitors) Adverse effects: Losatrix dty cough, high potassium (K) in the blood, extreme tiredness, pressurelowing down Losatrix is used for high BP, heart failure, diabetes-related kidney disease AT2 inhibitors (angiotensin Are used in case ACE drugs aren’t suitable for the patient. receptor blockers) Nitrates Improves tissue oxygen supply and Cause nitro-tolerance. During long-term medication there has to be free-nitrate period 8-12h daily. Nitrate-low period is a gap of 4 to 12 hours a day (usually when you are sleeping) where you do not take the tablets or capsules, is needed to make sure your medicine works properly. Digoxin (diuretic) Is a cardiac glycoside that treats heart failure. - decreases the SNS and activates parasympathetic NS, increases heart contraction - narrow therapeutic width - long half-life (40h) Warfarin (anticoagulant) - the most common anticoagulant - is not safe to use with very few interactions - inhibits (stops) synthesis of vitamin K-dependent coagulation factors - not recommended for pregnant and haemophilia people - taken once per day at the same time - poor therapeutic balance, slow effect - the weekly dosage has to remain same! INR (International Normalized Ratio) measurements for monitoring warfarin treatment. The amount of it stays the same during the week If more 12h has passed the forgotten dose is split in 2 Heparin Parental anticoagulant that blocks action of activated Fondaparinux (Arixtra®, blood clotting. Quixidar®) - i.v. heparin is strength of its anticoagulant effect varies significantly from patient to patient - may interact (reacts for) with aspirin or other NSAIDs, other blood thinners, digoxin, dipyridamole, hydroxychloroquine, indomethacin, nicotine (cigarettes, gum, lozenges, or skin patches),  nitroglycerin, antibiotics, and cold, allergy, or sleep medications Low dose ASA Inhibit platelet aggregation. Affect on fibrin formation and thromb development Levosimendan Simdax (i.v. levosimendan) is an inodilator (calcium sensitizer and potassium channel opener) indicated for the short-term treatment of acutely decompensated congestive heart failure  Neurological medicaments Migraine Medicamentations are used: *NSAIDs like ASA, diclofenac Voltaren, ibuprofein, ketoprofein, tolfenamic acid Clotam *Paracetamol *Triptants Triptans For migraines and cluster headache. If seizures occur more Sumatriptan than twice in a month, prophylaxis is considered. The medication starts in advance. - constrict dilated blood vessels - best effect within an hour of taking of the onset pain Interactions3 Interact with other medications that raise serotonin levels. This includes many antidepressants, tramadol and linezolid (Zyvox). Sumatriptan can tighten your blood vessels and raise your blood pressure. It shouldn't be used with other triptans or a class of medications called ergot derivatives Epilepsy Epilepsy can be with local onset or partial and generalized seizures. Local onset is the most common. Status epilepticus is a condition when seizures happen so often that the patient doesn’t recover between them. Adverse effects include dizziness, fatigue, imbalances. Some drugs can cause bone narrowing damage and mental disorders. It has to be followed by monitoring blood values (baseline, electrolytes, liver function) - meds have interactions with anticoagulants, antibiotics, chemo, contraceptives, antidepressants Medicaments are used: *Midazolam Buccolam oral intake for seizures *Phenytoin teratogenic medicine. with CYP enzymes weaken effects of certain meds *Phosphenytoin goes directly into a vein *Diazepam enema During the 1st trimester of pregnancy it’s recommended to take a folic acid supplement with the antiepileptic drugs Parkinson’s disease Degeneration and loss of dopamine-producing neurons in the midbrain. Impairment of dopaminergic functions there is risen acetylcholine-mediated activity. Medicaments are used: *Dopamine agonist Levadopa¸amantadine amantadine Atarin®, selegeline Eldepryl®, entacapone Stalevo® - increase dopamine production * anticholinergics Akineton®, Ipsatol® suppress cholinergic activity - not curable Dopamine can’t be used on its own cuz it doesn’t cross the blood-brain barrier. Levodopa is converted to a dopamine in the body. Levodopa drug Levodopa is a precusor of dopamine. It is converted to dopamine in the body. Unfortunately, it is metabolized by DDC and COMT 3 Drug interactions may make your drug less effective, cause unexpected side effects, or increase the action of a particular drug. Some drug interactions can even be harmful to you  enzymes before being converted into dopamine. DDC inhibitors (carbidopa or benserazide) and COMT inhibitors (entacapone Comtess®), tolcapone (Tasmar®) inhibit the levodopa-degrading enzyme activity described above → increase the amount of dopamine produced in the brain. - start Levodopa taking as late as possible - it loses effectiveness quickly - treatment is wear and tear - symptoms return before the next dose - discontinued gradually - risk of adverse effect is high Adverse effect: Nausea, burning, heartburn, dizziness, sweating, confusion, delusion, , arrythmias Alzheimer’s disease Slow steady-moving brain disease. - not hereditry - lack of acetylcholine4 in the brain - loss of cholinergic neurons - excessive amount of neurotransmitter glutamate make it difficult to make a memory mark - treated with acetylcholinesterase inhibitors Medicaments are used: *Acetylcholinesterase inhibitors donepezil Aricept®, galantamine, Reminyl® *Rivastigmine also treats moderate dementia for Parkinson’s *AKE inhibitors not used for patients with cognitive impairment or unclear memory impairment - tolerated well - glutamate neurotransmitor Memantine Multiple sclerosis Disease of the central NS caused by inflammatory mediators on nerve cells or damage of nerve tissues. Most common form is wave-progressive. Nortriptyline - treats nerve pain - treats mental/mood problems such as depression. It may help improve mood and feelings of well-being, relieve anxiety and tension - high risk medication 4 Медиатр, молекула, выделяемая аксоном  Respiratory diseases Lower respiratory infections Cough for 5-21 days is defined as acute bronchitis. Inflammation can turn into bacterial pneumonia, requiring antibiotic treatment. For pneumonia Amoxysillin and Doxycyline are used Rhinitis Medicaments used: *Anticholinergics Atrovent Nasal®, reduce nose secretion, use for non-allergic and allergic Asthma - used anti-inflammatory drugs - respiratory opening agents are used The aim of treatment is to eliminate and prevent inflammation. Most medicines are inhaled into the lungs. - drugs get directly to its place of action - a small amount of drug is needed - symptoms may be triggered by beta-blocker eye drops - acetylsalicylic acid and anti-inflammatory drugs exacerbate symptoms - inhalated drugs lower pH of the mouth, reduce saliva secretion Medicaments used: *Cortisone preparations relieve inflammation *Beta-s-agonists expand crammed bronchi People with asthma have double risk of dental caries. Taking the drugs: 1st the openenig drug (expanding bronchuses) 15 min later trrating drug (reducing inflammation) Respiratory anti-inflammatory Primary medication for asthma drugs Glucocorticoids beclomethasone Beclomet®, budesonide Pulmicort®, fluticasone Flixotide®, sclesonide Alvesco Inhaled chromes sodium chromogliate Lomedal – inhibit the activity of eosinophilic5 and neutrophilic white blood cells - reduce inflammation of the mucous membrane - prevent accumulation of inflammatory cells Adverse effects: Hoarseness of voice (охриплость), oral fungal infection Bronchial opening drugs *Short-acting inhalable beta-symptomiments salbutamol Ventoline ®, terbuthalin Bricanyl® - relax smooth muscular system on the bronchial wall - morning long-acting drugs minimize the dose of inhalated cortison - increase movement of mucous membrane villi (ворсинки) - remove foreign substences from the respiratory tract - extensive bronchial tubes Adverse effects: GI disorders, dry mouth, dizziness, headache muscle sheath, palpitations, heart rate agitation, arrhythmias COPD (Chronic obstructive Mild COPD - symptoms not often. Short-acting pulmonary disease) bronchodilators last about 4 to 6 hours Moderate COPD, needed long-acting bronchodilators that last about 12 hours or more. You take these every day. Severe COPD - symptoms flare up often, goes a combination of bronchodilators and an inhaled steroid. Steroids help reduce the inflammation or swelling in your 5 Эозинофилы – лейкоциты, борюбтся с многоклеточными паразитами  airways that makes it hard to breathe Medicaments used *Bonchodilators relax the muscles around your airways, opening them up to help make breathing easier *Combination of bronchodilators and steroids Insomnia medicaments SSIR’s (selective serotonin most tolerated and widely used to treat depression. reuptake inhibitors) medicaments Make the serotonin effect stronger by I nhibiting the (Cirpalex, Cipramil, Optipar) reuptake of serotonin in the nerve terminal. They don’t have any anticholinergic harm (dry mouth, tachycardia, dizziness) Adverse effects: Loss of appetite, nausea, changed sexual functions. May affect blood sugar lvl, a serotonin syndrome Double-acting antidepressants A double-acting antidepressant that affects the reuptake of (Bupropion, Duloxetine) dopamine and noradrenaline Mirtazapine doesn’t cause sexual disorders, GI symptoms Tricyclic antidepressants They strengthen the functioning of nerve cell terminals. Have a slow onset of action. NOT for elderly Serotonin syndrome Intoxication caused by excess serotonin in the CNS It can damage the kidneys and cause convulsions Benziodiazepines The primary sleeping pills for healthy adults. Relax Midazolam, Buccolam, Dormicum streated muscles and prevent convulsions. Cause addiction and impair memory Z-drugs Don’t change the structure of sleep as much as benzodiazepines. Low risk to addiction Melatonin Regulates sleep-awake rhythm, treats mild insomnia DOesn’t affect the memory and doesn’t brake sleep stages, not addictive. Palliative sedation The aim is to calm the patient down or put him to sleep in Midazolam, Dexmedetomidine, accordance with the severity of the symptoms, for Propofol, Haloperidol, Lorazepam example in case of imminent death by suffocation Medicaments used: Midazolam, and the average dose varied from 21 to 61 mg/day Dexmedetomidine has been used for longer in the sedation of intensive care patients. In intensive care, the subjects of sedation are often the patient's pain, anxiety and delirium Depressia Nortriptyline Treats nerve pain  GI and Constipation treatment Dyspepsia and GERD (reflux Drugs are used to neutralize gastric acidity and protect the disease) gastric mucosa from gastric acid. Can’t be used for long Esomeprazole, Lansoprazole time. Common complication is an inflammation of the lower part of esophagus. Medicaments are used: *Antacids (magnesium and aluminium hydroxide Novaluzid or calcium carbonate salts Rennie) *H2 blockers ( famotidine Pepcid, ranitidine Zantac, nizatidine ) *Proton pump inhibitors (lansoprazole Zolt, Somac) * Alginates over-the-counter medication used to help relieve symptoms of mild to moderate reflux. Are naturally occurring sugars that are found in brown seaweed. Reflux disease drugs have many interactions with other drugs Gastral mucosal protective agents: - sucralfate Antepsin, rantidine Pylorid) Antacids the less effective - neutralize gastric acidity and increase the tension of the lower esophageal sphincter - self-care products exit in several dosage forms - recommended usage 8 weeks - takes 2h before taking other drugs - magnesium-containing are the fastest antacids - aluminium hydroxide taken on an empty stomach neutralizes gastric acid H2 blockers Are inhibited by a hydrochloric acid secretion in the (Zitac, Zantac, Pepcid) stomach by blocking H2 receptors - suitable for use for couple of weeks for heartburn prevention Proton pump inhibitors - the most effective and quick acting - well tolerated - taken into an empty stomach - hydrochloric acid (соляная кислота) secretion reduces - reduce the absorption of B12-vitamin , iron and calcium - degrade (разрушаются) under the influence of gastric acidity Gastric mucosa protective agents Sucralfate (Antepsin) is a basic aluminium salt of sucrose Suralfate (Antepsin), alginate octasulfate that is activated in an acidic environment (Gaviscon) -cannot be taken with the antacids - reduce absorption of tetracycline, phразруша.рenytoin, digoxin, warfarin Peptic ulcer (язвенная болезнь) In stomach ventricles or the 1st part of small intestine (duodenum).  Caused by Helicobacter pylori infection or NSAIDs. Triple therapy is used to treat Helicobacter pylori: - PPI effective stomach acid-blocking drug - antibiotics penicillin and clarithromycin Klacid With penicillin allergy Amoxillin can be replaced with Metronidazole. Constipation treatment Caused by low fluid and fibre intake, lack of exercise, age- related changes Laxatives medicaments are used: *Bulk laxatives – increase intestinal contents or faeces bulk * Osmotic laxatives – increase colonic fluid. For empty rectum * Contact laxatives - stimulate intestines. For soft stool * Faecal softening and lubricating peparations – for hard stool Nausea and vomiting Serotonin receptor blockers ondansetron Zofran and treatment gainsetron Scopolamine is an active natural alkaloid that blocks action of acetylcholine. Used for motion sickness and seasickness Primperan Bulk laxatives They contain seeds and shells that enhance bowel’s own activity. contain fibres which increase the mass and dry weight of feces. - increase intestinal content - suitable for long-term use - may cause low potassium (K), flatulence (метеоризм) Osmotic laxatives - increase fluid in the large intestine - decreases pH of the intestinal fluid - softens intestinal contents - doesn’t’ develop dependence - suitable for long-term use Contact laxatives and softening They affect intestinal wall mucosa of the colon and speed enemas up the passage of intestinal contents. - don’t’ affect intestinal reflux - suitable for short term (10 days) *Methylnaltrexone bromide *castor and paraffin oil lubricates stool mass Chronic inflammatory intestine - treatment of inflammation with glucocorticoids Ulcerative colitis - anti-recurrence of inflammation with 5-ASA and sufalazin Crohn’s disease6 - immunosuppressors 6 type of inflammatory bowel disease (IBD). It causes swelling of the tissues (inflammation) in your digestive tract, which can lead to abdominal pain, severe diarrhea, fatigue, weight loss and malnutrition  Sensory diseases Ophthalmic (eye) drugs Several drugs used to treat eye diseases affect the system ⇨ sympathetic and parasympathetic irritation functioning of the autonomic nervous in the eye Locally administered drugs are absorbed into the eye through the cornea Only 1-5% of the drug is absorbed in the eye 1st water-soluble drugs are administered 2nd oil oil-based medicaments The eye moistening drops go last After the drops the eye cream is applied. All eye creams are applied underneath and around the eye, but not all of them can be used on the upper lids Pessing the eyelid of the inner corner of the eye can avoid systemic effects 1st watery then gel-like drop are administered. The last one is a creamy eye drop. 5 min break between drops. Can be stored open for a month. Room temperature during administrating Glaucoma Medicaments are used: * cholinergic medicinal products (parasymatomiments) * Beta blockers (Timolol, Betaxasolol) – tolerability of eye drops is usually good. Should not be used in patients with asthma, obstructive pulmonary disease or unbalanced heart failure * Adrenergic medicinal (sympathomimets) – expand the pupil. The effect begins quickly * Prostaglandin analogues – cause conjunctivitis and change eye colour, makes eyelashes longer * Local inhibitors of carbonic anhydrase - can cause systemic adverse reactions - the only way of treatment is to decrease eye pressure - given as drops - aims to reduce the formation of ventricular fluid in the back chamber, or to increase its outflow from the front chamber Mydriasis Pupil dilatation sensitises the eye to light, because the iris does not react to light when using mydriases. Information of the patient Can cause tachycardia and central NS symptoms Ear diseases Medicaments used: * Antimicrobials * Anti-inflammatory drugs * Paracetamol * Penicillin or Amoxicillin Antibiotic treatment is for bacterial infection Glucocorticoid treatment is for allergy  Skin medications Creams Medical cream is applied before base cream Basic creams - shouldn’t be too watery or greasy - ointments are best absorbed when applied on moist skin after the shower Cortisone creams - relieve eczema symptoms - prevent inflammation - reduce swelling and watering - control allergic reactions Applied to the rash area with a thick layer. Effectiveness depends on age and skin area. When switching to a stronger product the risk of adverse effect increases Glucocorticoid creams can’t be used randomly or for broken skin. They are absorbed into the bloodstream. Absodption can be enhaced by opaque occultation. Glucocorticoids have systemic effects A 10 day break is taken between 1-3 week period of usage. Compound (комплексные) creams - treats bacterial or fungal infections or soften cornea layer Calcineurin inhibitors - equivalent of medium-strength glucocorticoids Immunomodulators - used for all skin areas except mucous membranes - treats unresponsive atopic dermatitis, inflammation - not used during pregnancy and lactation Adverse effects: skin burning. Itching, redness. Other creams can be used after 2h. Urticaria (крапивница) treatment Medications used Fexofenadine, Loratadine *Antihistamines that don't make you drowsy are preferred. They are effective and long-lasting (may be taken once a day) and have few side effects. A combination of two or three antihistamines to treat your hives, along with cold compresses or anti-itch balms to ease the symptoms Benadryl (diphenhydramine), an older antihistamine, is generally avoided during the daytime as it can cause drowsiness  Cancer medicaments Medical treatment includes the prevention of harm caused by another medicines. Medicaments are used: *Chemotherapy or cell blocker *Endocrine agents, hormone treatment *Biological medicinal products Cell blockers - destroy cancerous tumors, strengthen the results of surgical or radiotherapy - reduce metastasis and relieve symptoms - cell blockers are affected by dividing cells - pass through all over the body circulation - narrow therapeutic width Chemotherapy Is usually a combination of a few medicines in 2-4 weeks over a few months. Is given as adjuvant therapy (which follows after the basic treatment) during or after surgery. Chemo is the most effective at killing rapidly dividing cells - it’s teratogenic (вызывание врожденных уродств химическими элементами) - it exposed through the skin, GI channel or respiratory tract - infusion has to have a closed connector - the infusion is prefilled with saline or glucose solution Adverse effects: Affect GI tract, nausea, vomiting, constipation, skin mucous membrane damage, neuropathy, bone narrow damage Hormone therapy Targeted treatment for breast and prostate cancer, thyroid cancer and uterine body cancer - tolerated well compared to chemo - years-long therapy - estrogen stimulated the breast cancer cells - antiestrogen prevents intracellular estrogen effect Medicamentation used: *Aromatase inhibitors reduce formation of estrogen Arimidex, Femar *Anti-androgen influencer prostate cancer, blocks the male hormone effect in cancer cells *Antagonist and agonist of hormones (GnRH) treat hormonal cancers *Glucocorticoids treat leukemias and lymph tumors *Thyroid hormone Biological drugs Biological anticancer drugs, targeted drug treatment. Affects immunology including interferons7, monoclonal antibodies and interleukin Kinds of treatment: *Interferons slow down the distribution of cancer cells and increase the activity of natural killer cells *Monoclonal antibodies used for immunological diseases such as rheumatism: rituximab, trastzimab, setumib 7 Ряд белков выделяемый организмом в ответ на вторжение вируса  Autoimunne diseases Chron’s disease Rheumatoid arthritis It’s a disease where immune defence is overloaded and the bones and joints are about to be damaged. Starts with pain in joints. The treatment is aimed to get rid off the symptoms Primary medicine is low-dose glucocorticoid. - the effect remains for a long time *Methotrexate taken once per week. Overdose can be fatal. *Chlorocine and hydroxychlorocine may cause more seizures than in epilepsy. Treats malaria as well *Chemotherapy *Gold Treatment gold injected into the muscle or auranophin tablets. The treatment is usually stopped due to side effects such as low Hb, leuko and thrombocytes. *Cell blockers Leflunomide, Cyclophosphamide Sendoxan treats active rheumatism. Not used during pregnancy and lactation. Is mutagenic and potentially carcinogenic. The other drugs are biological drugs, analgetics, reducing skeletal spasms drugs. Diabetes 1 Diabetes 2 Multiple sclerosis Psoriasis Methotrexate Pernicious anemia Lack of erythrocytes. Intestines donät obserb B12 vitamin which forms red blood cells and DNA production Infusion Places for IV infusion Non-dominant hand, peripheral vein, distal vein of the back of the palm or forearm Saphenous (foot) vein IT IS NOT placed in the hand with the lymoh nodes removed from the armprints or with AV shunt Penicillins are bacteriostats drugs inhibiting the division of bacterias. (false) 1. Cardiovascular diseases, part 2 (heart failure and antithrombotics) 2. Meds for neurological diseases 3. Meds for gastrointestinal diseases, pre-assignment case 4. Cancer diseases 5. Meds for skin diseases 6. Meds of sensory diseases 7. Meds for respiratory 1. What or which of the following claims are true? A) The patient was first given an enema triggering fecal benefit to initiate anti- constipation therapy. B) Faecal benefit was first softened with osmotic laxative (macrogol) to better and less painfully remove it by enema. C) First, the patient was given a colon stimulating medication and then an enema. D) Faecal obstruction cannot be triggered by enema unless it is soft enough. 2. Constipation treatment based on the addition of dietary fibre could be initiated for the patient because: A) Intestinal obstruction had been removed B) She had no intestinal obstruction C) Faecal softening drugs had not worked D) She is able to ingest sufficient fluid 3. If fibre therapy is not effective, the patient may be given the A) Laxative stimulating the colon as a currant B) Osmotic laxative as a cure C) Faeces softening enema D) Add fibre-containing laxative