BIO290 Pharmacology Lecture Outline 2024 PDF
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Uploaded by RejoicingChaparral
Joyce University of Nursing and Health Sciences
2024
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This document is a lecture outline for a pharmacology course at Joyce University of Nursing and Health Sciences, for the week of July 5, 2024. The outline covers topics such as introductions to pharmacology, anti-infective drugs, and more.
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** ** ===== **BIO290: Pharmacology** ======================== Lecture Outlines ================ **\ ** **Table of Contents** **Introduction..................................................................................................................... 3** **Module 1: Introduction to Pharm...
** ** ===== **BIO290: Pharmacology** ======================== Lecture Outlines ================ **\ ** **Table of Contents** **Introduction..................................................................................................................... 3** **Module 1: Introduction to Pharmacology.................................................................... 4** **Module 2: Anti-Infective Drugs.................................................................................... 15** **Module 3: Immunomodulators & Antineoplastic Agents......................................... 26** **Module 4: Pain & Substance Abuse............................................................................ 37** **Module 5: Mental Health, Epilepsy, & Anesthesia.................................................... 53** **Module 6: Bone & Skin Disorders.............................................................................\....67** **Module 7: Autonomic Nervous System Medications.....................................\........... 78** **Module 8: Endocrine Medications............................................................................... 91** **Module 9: Cardiovascular Drugs Part 1....................................................................\... 99** **Module 10: Cardiovascular Drugs Part 2....................................................................112** **Module 11: Diuretics, IV Fluids, & Treatment of Poisoning..................................\...120** **Module 12: Respiratory & Eye/Ear Drugs.................................................................. 127** **Module 13: Gastrointestinal Medications..................................................................136** **Module 14: Reproductive Medications.......................................................................144** **Appendix A: Latin Abbreviations..................................................................\.............. 151** **Appendix B: Drug Prefixes & Suffixes......................................................................... 152** **Appendix C: Blank Drug Cards..................................................................................... 159** **\ ** Introduction: ============= This outline has been created to assist students in focusing their study of pharmacology at Joyce University of Nursing and Health Sciences. It has been designed to align with lecture and exam content. These outlines are available as a Microsoft Word document, allowing students to increase spacing or add lines for notes as they choose. The outline also includes supplementary study aids in the appendices. ======================================================================================================================================================================================================================================================================================================================================================================================================================= Tips for Success: ================= The pharmacology course at Joyce University is based on a \"flipped classroom model.\" To succeed in this course, students must watch the pre-recorded lecture videos within the Canvas modules. We highly encourage students to use these lecture outlines to take notes while watching the pre-lecture videos. Homework assignments and live lecture/tutoring sessions are designed to deepen students\' understanding of key concepts and address any areas that are complex, confusing, or require additional instruction. Throughout this lecture outline, there are opportunities to fill in the blanks, answer questions, and complete charts to help the student ensure understanding of the material presented in the lecture videos. Make note of any topics that you are struggling with and any questions that you have for the instructor so that they can be addressed during your live lecture/tutoring session. Module quizzes have been created to assess comprehension and proficiency in module material. The quizzes are to be taken without the use of notes or outside sources. We recommend taking the module quizzes after spending considerable time with the module content. This course is fast-paced and is intended to provide students with a foundational understanding of key pharmacological principles, which will be built upon in nursing courses throughout the rest of the program. The pharmacology course is aligned with the pathophysiology course so that, whenever possible, students learn about the same body system in each course. The exams in pharmacology and pathophysiology have been staggered, except for the final exam. Typically, students will take their pathophysiology and pharmacology exams on alternating weeks. Diversity, Equity, and Inclusiveness Statement ============================================== Joyce University of Nursing and Health Sciences is strongly committed to the principles and practices of diversity, equity, and inclusion throughout the university community. The pictures and language used in this resource have been chosen with these principles in mind. Copyright Information ===================== This document is copyright of Joyce University of Nursing and Health Sciences. When referencing this source, the following citation may be used: Joyce University of Nursing and Health Sciences. (2024, July). Pharmacology Course Outline. **\ ** **Module 1---**Week 1 **Module 1 Topics //** Introduction to Pharmacology **Term** **Definition** ----------------- ---------------- Pharmacology Pharmacotherapy Drug Placebo Prototype Ideal Drug **Characteristics of an Ideal Drug** 1\. Effectively treats, prevents, or cures client's condition 2\. Produces a rapid and predictable response at low doses 3\. Quickly eliminated by body after therapeutic effect produced 4\. Can be taken infrequently or for a short length of time 5\. Cheap and easily accessible 6\. Administered conveniently 7\. Produces no adverse effects 8\. Does not interact with other medications or food **Drug Naming** - Trade Name (a.k.a. Brand Name) - Created by drug company - Possibility of multiple names - Easier to remember / pronounce - Must be approved by FDA - First letter capitalized - Examples: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ - Generic Name - Only 1 generic name - First letter lower case - Examples: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ - Chemical Name - Long/complex - Examples: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **Drug Classification** - Therapeutic Class - What condition is being treated by the drug - Examples: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ - Pharmacologic Class - How the drug acts - Examples: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **Drug Development and Approval** 1. Laboratory Research 2. Pre-Clinical Research 3. Clinical Trials a. Phase 1 - Safety b. Phase 2 - Effectiveness c. Phase 3 - Patient Variability & Drug Interactions 4. Government Review 5. Post-Marketing Surveillance **Controlled Drug Schedules\ ** +-----------------------+-----------------------+-----------------------+ | **Schedule** | **Description** | **Drug Examples** | +=======================+=======================+=======================+ | 1 | All non-research use | | | | illegal under federal | | | | law | | | | | | | | Highest potential for | | | | abuse | | +-----------------------+-----------------------+-----------------------+ | 2 | Accepted medical use, | | | | but high potential | | | | for abuse leading to | | | | severe | | | | psychological/physica | | | | l | | | | dependence | | | | | | | | Severely restricted, | | | | no telephone | | | | prescriptions, no | | | | refills | | +-----------------------+-----------------------+-----------------------+ | 3 | Accepted medical use, | | | | moderate to low | | | | dependence risk | | | | | | | | Prescription | | | | re-written after 6 | | | | months (or 5 refills) | | +-----------------------+-----------------------+-----------------------+ | 4 | Accepted medical use, | | | | low potential for | | | | abuse/dependence | | | | | | | | Prescription | | | | re-written after 6 | | | | months (or 5 refills) | | +-----------------------+-----------------------+-----------------------+ | 5 | Accepted medical use, | | | | contain limited | | | | quantities of certain | | | | narcotics | | | | | | | | Lowest risk for abuse | | +-----------------------+-----------------------+-----------------------+ **Legal Classification of Drugs** - Prescription (Rx) - Available to only those authorized (i.e., prescribed) - May require training/skill to administer - May be addictive and therefore regulated - Treat complex conditions - Can become OTC - Over-the-Counter (OTC) - Available to general population - No assistance from healthcare provider - May be harmful of ineffective **Pharmacokinetics** -- how medications travel through the body *Bioavailability:* Amount of a drug that reaches the blood stream after administration - What dosage form has the highest bioavailability? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *First Pass Effect (a.k.a. first pass metabolism):* When a drug is absorbed through the intestines, it will enter the mesenteric circulation which passes through the liver before entering general circulation. As it passes through the liver, some of the drug can be broken down or redirected to the bile, thereby reducing the amount that eventually makes it into circulation (i.e., reduces bioavailability). - If a drug can be given enterally or parenterally, which dosage form would require a lower dose to achieve the same effect? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ - Why? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [Routes of Administration:] - **Enteral** -- oral (tablet, capsule, controlled release, sustained release), sublingual, buccal, nasogastric tube, rectal - Pros: convenient, cheap, self-use - Cons: subject to first pass effect, gastric irritation, slow effect, need to be conscious, can't be vomiting - **Parenteral** -- intravenous, intramuscular, subcutaneous, intradermal, epidural - Pros: rapid effect, avoid gastric irritation, can be used in unconscious - Cons: aseptic technique, painful, expensive, risk of nerve injury, requires training to administer - What is a depot injection? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ - **Topical** -- transdermal, eye (ocular), ear (otic), vaginal - Pros: high local concentration, minimal systemic effect - Cons: slow effect, localized, limited drug options, systemic effect with tissue destruction - How should transdermal patches be administered? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ - **Inhalation** -- vaporization, gas inhalation, nebulization - Pros: rapid effect, large surface area for absorption - Cons: hard to regular dosage - Factors that affect the choice of route: - Drug properties - Site of desired location - Rate/extent of absorption - Effect of digestive juices - Effect of first pass metabolism - Onset of response - Accuracy of dose - Client condition [Phases of Pharmacokinetics] 1. Absorption -- process from administration to arriving in the bloodstream a. Consider bioavailability - What factors affect drug absorption? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 2. Distribution -- transportation from blood stream (or other fluids) to the location(s) of action b. Consider blood-brain-barrier (BBB), fetal-placental barrier, drug solubility (affects binding to plasma proteins, such as albumin) - What factors affect drug distribution? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 3. Metabolism -- breakdown and transformation of the drug c. Primary site: liver - What factors affect metabolism? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 4. Excretion/Elimination -- elimination of the medication from the body d. Primary site: kidney - What factors affect excretion? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **Pharmacodynamics --** how medications interact with their targets to produce effects **Term** **Definition** -------------------- ----------------------------------------------------------------------------------------------------- Agonist Drug that binds to a receptor to cause an effect Partial Agonist Drug that binds to a receptor and causes a partial effect Antagonist Drug that binds to a receptor, but does not cause an effect Loading Dose Higher amount of drug administered to quickly establish therapeutic levels Maintenance Dose Lower amount of drug administered to keep concentration within therapeutic range (i.e., usual dose) Peak Level Highest drug concentration of medication in an individual Trough Level Lowest drug concentration of medication in an individual Onset of Action Time it takes after administration to reach minimum therapeutic effect Peak Effect/Level Time it takes after administration to reach maximum therapeutic effect Duration of Action The time that the drug concentration remains within the therapeutic range after a dose. [Therapeutic Index/Window]: the dosage range in which the medication has a therapeutic effect without causing toxicity - Toxic Dose -- Minimum Therapeutic Dose - Which is safer, a drug with a low/narrow therapeutic index or a drug with a high/wide therapeutic index? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [Half Life]: the amount of time it takes for the plasma drug concentration to reduce by half its original value - A woman takes a zolpidem (Ambien) at 8pm in order to go to bed. If she takes a 6mg dose, and the half-life of zolpidem is 2 hours, what is the concentration in her plasma at 4am? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [Efficacy]: the maximum therapeutic response that can be achieved from a drug [Potency]: the amount of drug required to produce a specific effect [Tolerance]: requiring increasing amounts of a drug over time to elicit the same effect [Dependence]: the body begins to rely on a substance in order to function such that in the absence of the substance, the body begins to experience adverse (even life-threatening) effects (i.e., withdrawal) **Drug Effects\ ** [Side Effect]: predictable, expected, occur at therapeutic dose [Adverse Effect]: harmful, undesirable, may occur at or above therapeutic dose [Black Box Warning]: label FDA warning of the potential for severe adverse effects [Allergic Reaction]: immune-mediated response that occurs relatively rapidly after administration of a medication - Mild -- pruritis (itching), rash - Anaphylaxis -- severe reaction involving multiple body systems, treat with epinephrine - Respiratory: chest tightness, airway swelling, hoarseness, wheezing, difficulty breathing - Cardiovascular: chest pain, hypotension, rapid heart rate - Skin: urticaria (hives), flushing, pruritis, angioedema (swelling of tongue, face, throat) - CNS: anxiety, headache, confusion, drowsiness - GI: nausea/vomiting, diarrhea, cramping [Toxicities:] - Teratogenicity -- cause harm to the developing fetus and cause birth defects - Nephrotoxicity -- cause damage to the kidneys - Monitor BUN, creatinine - Drug causes: DAAMN (diuretics, ACE inhibitors/Angiotensin receptor blockers, aminoglycosides, metformin, NSAIDs) - Hepatotoxicity -- cause damage to the liver - Monitor liver function tests (LFTs) - Signs/Symptoms: jaundice - Neurotoxicity -- cause damage to the brain or nerves - Signs/Symptoms: headache, neuropathy, confusion - Dermatologic toxicity -- causes damage to the skin - Rash, pruritis, angioedema, photosensitivity, Stevens-Johnson Syndrome - Drug causes: antiepileptic drugs, sulfa drugs - Ototoxicity -- causes damage to the ear - Tinnitus, hearing loss - Drug causes: aminoglycosides (e.g., gentamycin) - Musculoskeletal toxicity -- causes damage to muscles or tendons - 'Statin' drugs cause rhabdomyolysis - Fluoroquinolone antibiotics (e.g., levofloxacin, ciprofloxacin) cause tendonitis/rupture - Bone marrow suppression -- causes damage to bone marrow, resulting in impaired production of red blood cells (RBCs), white blood cells (WBCs), and platelets - Low RBCs → anemia, fatigue, paleness, weakness, falls - Low WBCs → fever, infection, cough - Low platelets → bleeding, bruising, petechia - Drug causes: antineoplastic agents - Cardiotoxicity -- causes damage to the heart - Prolonged QT interval can lead to Torsade's de Pointes, an abnormal heart rhythm that can lead to sudden cardiac death - Drug causes: doxorubicin [Drug Interaction] -- a change in the way a drug acts in the body when taken alongside another drug, food, or other substance - Warfarin - Green leafy vegetables (high in vitamin K) - Statins - Grapefruit juice - Acetaminophen - Alcohol - MAOI antidepressants - Cheese, cured meats, ripe fruit **Medication Error Reduction Strategies** - Up-to-date knowledge - Stick to what you know - Scan & confirm (barcode technology) - Consult interdisciplinary teams - Write it out - Do not store look-alikes together - Do not store sound-alikes together - Double check high-alert medications - Double check neonatal prescriptions **Geriatric Care** Physiological Changes in the Elderly - Weaker Hearts: reduced cardiac output less circulation of medication - Blood Pressure: weaker vascular control increased risk of orthostatic hypotension, bradycardia, tachycardia falls, fractures, immobility - Reduced Kidney Function: less ability to ELIMINATE medications increased risk of renal injury - Reduced Liver Function: less ability to METABOLIZE medications increased accumulation of drugs - Decreased Muscle: reduced body mass reduced volume of DISTRIBUTION increased accumulation of medicine due to less of an area for them to distribute - Thinner skin: Increased efficiency of topical medications [Polypharmacy] - ≥5 medications - Increased risk of drug interactions - Increased risk of adverse effects - Complicated drug regiments may reduce adherence [Beers Criteria] -- list of medications to use with caution in elderly clients due to an increased risk of experiencing adverse effects +-----------------------------------+-----------------------------------+ | **Drug** | **Adverse Response** | +===================================+===================================+ | Antihistamines (-[iramine or | Sedation, confusion, | | -amine)] | anticholinergic effects, falls | | | | | (e.g., | | | chlorphen[iramine], | | | diphenhydr[amine], | | | hydroxyzine, promethazine) | | +-----------------------------------+-----------------------------------+ | Antipsychotic drugs | Increased mortality (in patients | | ([-ridone)] | with dementia-related psychosis), | | | increased confusion, sedation | | (e.g., chlorpromazine, clozapine, | | | rispe[ridone]) | | +-----------------------------------+-----------------------------------+ | Benzodiazepines ([-azolam or | Confusion, depression, over | | -azepam)] | sedation, falls, risk with | | | driving | | (e.g., alpr[azolam], | | | lor[azepam], | | | ox[azepam]) | | +-----------------------------------+-----------------------------------+ | Digoxin | Reduced renal excretion (in | | | patients with pre-existing | | | chronic kidney disease), so | | | potential for digoxin toxicity | +-----------------------------------+-----------------------------------+ | Muscle relaxants | Sedation, anticholinergic effects | | | | | (e.g., cyclobenzaprine, | | | oxybutynin) | | +-----------------------------------+-----------------------------------+ | Nonsteroidal Anti-Inflammatory | Increased BP, nephrotoxicity, | | Drugs (NSAIDs) | fluid retention, aggravates Heart | | ([-profen]) | failure, GI bleeding | | | | | (e.g., aspirin, | | | ibu[profen], | | | naproxen) | | +-----------------------------------+-----------------------------------+ | Opioid analgesics \...IV | Sedation, confusion, falls, | | | reduced breathing, constipation | | (e.g., hydromorphone, morphine, | | | oxycodone) | | +-----------------------------------+-----------------------------------+ | Blood thinners | Increased GI bleeding, bleeding | | ([-parin] or | with falls | | -[farin] or | | | -[grel]) | Combined are high risk for sure | | | | | (war[farin], | | | he[parin], | | | clopido[grel]) | | +-----------------------------------+-----------------------------------+ Strategies for Improving Medication Adherence - Ask the pharmacy to use non-safety caps - Caution: ask the client first because you should not do this if the household has small children - Use large font on pill bottles and instructions - Provide patients and/or their caregivers with adequate instructions - Pill reminders - Simplify the drug regimen **Complementary and Alternative Medicines\ ** [Dietary Supplement Health and Education Act (DSHEA)] -- exempts dietary supplements from FDA standards (treats them like food) [Herbal Medications] -- nutritional supplement sold without a prescription and lack FDA approval [Alternative Medicine] -- therapies that fall outside of conventional medicine (naturopathy, yoga, hypnosis, acupuncture) [Synergism] -- the total effect of 2 drugs combined is equal to the effect of both drugs when taken individually [Agonism] -- the total effect of 2 drugs combined is greater than the effect of both drugs when taken individually [Antagonism] -- the total effect of 2 drugs combined is lesser than the effect of both drugs when taken individually [GABA (gamma-amino butyric acid)] -- amino acid neurotransmitter in the CNS that inhibits nerve transmission and reduces neuronal excitation within the CNS **Herbal Supplements** +-------------+-------------+-------------+-------------+-------------+ | **Name** | **Uses | **Mechanism | **Effects** | **Specials* | | | (Indication | of Action** | | * | | | s)** | | | | +=============+=============+=============+=============+=============+ | **Aloe** | Topical: | Anti-inflam | Oral -- | Oral -- | | | burns, | matory, | fluid/elect | contraindic | | | soften | analgesic, | rolyte | ated | | | skin, | laxative | imbalance, | in renal & | | | psoriasis | | cramping | cardiac | | | | | | disorders | | | Oral: | | | | | | constipatio | | | | | | n | | | | +-------------+-------------+-------------+-------------+-------------+ | **Black | Post-menopa | Estrogen | Blood | Contraindic | | Cohosh** | usal | substitute | thinning, | ated | | | symptoms, | | hepatotoxic | in | | | premenstrua | | ity, | pregnancy, | | | l | | GI upset, | breast | | | syndrome | | headache | cancer, | | | (PMS) | | | renal | | | | | | disease, | | | | | | hepatic | | | | | | disease | +-------------+-------------+-------------+-------------+-------------+ | **Cannabis* | Cachexia, | Activates | Increased | Contraindic | | * | N/V, pain, | cannabinoid | appetite & | ated | | | spasticity | receptors | weight | in asthma, | | | | in the CNS | gain, | cardiac | | | | | increased | disease | | | | | heart rate, | | | | | | sleepiness, | | | | | | dry mouth, | | | | | | dry eyes, | | | | | | paranoia, | | | | | | impaired | | | | | | memory and | | | | | | attention | | +-------------+-------------+-------------+-------------+-------------+ | **Echinacea | Boost | Stimulates | Allergic | Requires | | ** | immunity | the immune | reaction, | functional | | | | system | Fever, GI | immune | | | | | upset | system: | | | | | | contraindic | | | | | | ated | | | | | | in | | | | | | immunocompr | | | | | | omised | +-------------+-------------+-------------+-------------+-------------+ | **Feverfew* | Migraines, | Inhibits | Post-feverf | Contraindic | | * | arthritis | platelet | ew | ated | | | | aggregation | syndrome, | with blood | | | | | GI upset, | thinners, | | | | | bleeding | pregnancy, | | | | | | surgery | +-------------+-------------+-------------+-------------+-------------+ | **Garlic** | Atheroscler | Increases | Bleeding, | Contraindic | | | osis, | HDL, | GI upset, | ated | | | heart | reduces | bad breath, | with blood | | | disease, | LDL, | body odor | thinners, | | | high | inhibits | | hemophilia, | | | cholesterol | platelet | | surgery | | | , | aggregation | | | | | high blood | , | | | | | pressure | induces | | | | | | vasodilatio | | | | | | n | | | +-------------+-------------+-------------+-------------+-------------+ | **Ginger** | Nausea, | Relieves | Bleeding, | Contraindic | | | upset | vertigo and | Hypoglycemi | ated | | | stomach, | nausea, | a | with blood | | | morning | increases | when taken | thinners, | | | sickness, | gastric | with | pregnancy | | | motion | motility, | diabetic | | | | sickness | decreases | drugs | | | | | GI spasms, | | | | | | Inhibits | | | | | | platelet | | | | | | aggregation | | | +-------------+-------------+-------------+-------------+-------------+ | **Ginkgo | Dementia, | Promotes | Possible | Contraindic | | biloba** | arterial | vasodilatio | seizures, | ated | | | occlusion, | n | headache, | with blood | | | thins blood | and | GI upset | thinners, | | | | increased | | antihistami | | | | blood flow | | nes, | | | | to | | antidepress | | | | | | ants, | | | | brain, | | antipsychot | | | | decreases | | ics | | | | platelet | | | | | | aggregation | | | +-------------+-------------+-------------+-------------+-------------+ | **Ginseng** | Improve | Ginsenoside | Insomnia, | Contraindic | | | memory, | effects | hypoglycemi | ated | | | dementia, | | a, | in | | | erectile | | bleeding | pregnancy, | | | dysfunction | | | bleeding | | | | | | | | | | | | disorders, | | | | | | use with | | | | | | warfarin, | | | | | | autoimmune | | | | | | disease | +-------------+-------------+-------------+-------------+-------------+ | **Glucosami | Osteoarthri | Stimulates | Bleeding, | Contraindic | | ne** | tis, | cells to | heartburn, | ated | | | joint | make | nausea, | with blood | | | inflammatio | cartilage | shellfish | thinners | | | n | and | allergy | | | | | synovial | | | | | | fluid, | | | | | | suppresses | | | | | | inflammatio | | | | | | n | | | | | | of joints, | | | | | | decreases | | | | | | cartilage | | | | | | degradation | | | +-------------+-------------+-------------+-------------+-------------+ | **Kava** | Insomnia, | Promotes | Dry, flakey | Contraindic | | | anxiety, | sleep, | skin, | ated | | | muscle | decreases | hepatotoxic | with other | | | cramping | anxiety, | at large | CNS | | | | muscle | doses | depressants | | | | relaxant, | | , | | | | Possible | | including | | | | GABA effect | | alcohol | +-------------+-------------+-------------+-------------+-------------+ | **Omega-3 | Hypertrigly | Inhibits | Arthralgia, | Contraindic | | Fatty | ceridemia, | thromboxane | GI upset, | ated | | Acids** | reduce risk | , | Belching, | in | | | of | prostagland | fish/seafoo | pregnancy | | | MI/Stroke, | ins, | d | | | | improve | leukotriene | allergy | | | | Brain | s | | | | | function, | | | | | | visual | | | | | | acuity | | | | +-------------+-------------+-------------+-------------+-------------+ | **Saw | Benign | Reduces | Blood | Contraindic | | Palmetto** | prostatic | prostate | thinning, | ated | | | hyperplasia | enlargement | GI Upset | with | | | (BPH) | | | finasteride | | | | | | , | | | | | | blood | | | | | | thinners, | | | | | | pregnancy | +-------------+-------------+-------------+-------------+-------------+ | **St. | Mild | Increases | Serotonin | Contraindic | | John's | depression, | serotonin, | syndrome, | ated | | Wort** | mild pain | analgesic | photosensit | with | | | | | ivity, | antidepress | | | | | dry mouth, | ants, | | | | | constipatio | amphetamine | | | | | n | , | | | | | | cocaine | +-------------+-------------+-------------+-------------+-------------+ | **Valerian* | Insomnia, | Increases | Drowsiness, | Contraindic | | * | anxiety | GABA | Depressive | ated | | | | effects | effects, | in | | | | | risk of | pregnancy, | | | | | dependence | breastfeedi | | | | | | ng, | | | | | | CNS | | | | | | depressants | | | | | | , | | | | | | including | | | | | | alcohol | +-------------+-------------+-------------+-------------+-------------+ **Notes:** - *Nursing* *Foundation\ * **\ Module 2---**Week 2 **Module 2 Topics //** Anti-Infective Drugs **Introduction to Antibiotics** - A group of medications that are used to target bacteria. - General adverse effects: GI disturbance (nausea, vomiting, diarrhea), oral thrush, GI supra-infection (e.g. C. diff.), allergic reaction (apply to all antibiotic drug cards) - Tests used to identify the type of bacteria: - [Sample] - from saliva, sputum, blood, secretions, tissue, urine, etc. - [Gram stain] - a dye is used that essentially gets trapped in the thick peptidoglycan layer of Gram-Positive bacteria, causing them to look purple. The dye is not trapped in the single peptidoglycan layer in Gram Negative and washes out (appearing red). - [Culture] - A patient sample that is grown within a laboratory setting to help identify which bacteria is present - [Sensitivity] - Bacterial culture is subjected to a variety of antibiotics to determine which are most effective against the pathogen present - Broad Spectrum vs Narrow Spectrum - [Broad Spectrum] - Used before culture and sensitivity - Target a wide range of bacteria - More likely to cause adverse effects - **What are some examples of broad-spectrum antibiotics?** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ - [Narrow Spectrum] - Used after culture and sensitivity - Target specific groups of bacteria - Lower risk of adverse effects - **What are some examples of broad-spectrum antibiotics?** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ - Bactericidal vs Bacteriostatic - [Bactericidal] - Antibiotics that KILL bacteria - Irreversible - Independent of host immunity - **Examples of bactericidal drugs:** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ - [Bacteriostatic] - Antibiotics that prevent bacterial GROWTH - Reversible - Co-dependent on host immunity - **Examples of bacteriostatic drugs:** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ - [Antibiotic Resistance] -- occurs when bacteria evolve to become resistant to available medications - **What are some factors that contribute to the development of antibiotic resistance?** - \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ - \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ - \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ - \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ - **What strategies can reduce the incidence of antibiotic resistance?** - \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ - \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ - \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ - \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ - [Prophylaxis] - when an antibiotic is given in an attempt to prevent the client from getting sick - **What is an example of antibiotic prophylaxis?** **Antibiotic Drug Monographs** - Antibiotic or antimicrobial would be the therapeutic class for this entire group of medications - Antibiotics can also be grouped by pharmacological class based on their mechanism of action - Common adverse effects: **most antibiotics cause nausea, vomiting, & diarrhea. \*Apply this group of side effects to all the following antibiotics. \*** **[Beta-Lactam Antibiotics]** - Bactericidal antibiotics that inhibit the bacterial cell wall **Peni[cillin] G** (Similar drugs: peni[cillin] V, amoxi[cillin], ampi[cillin]) +-----------------------------------+-----------------------------------+ | **Pharmacological Class** | Penicillin (PCN), beta-lactam | | | antibiotic | +===================================+===================================+ | **Indication** | Bacterial Infections (Gram + | | | Cocci), strep throat, dental | | | procedures (prophylaxis) | +-----------------------------------+-----------------------------------+ | **Contraindication** | Penicillin allergy, renal disease | +-----------------------------------+-----------------------------------+ | **Adverse Effects** | Allergic reaction, | | | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ | | | _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ | +-----------------------------------+-----------------------------------+ | **Specials** | Administered only parenterally | | | (IV, IM) | | | | | | Monitor: up to 30 min post | | | administration, BUN / Creatinine | +-----------------------------------+-----------------------------------+ **[Ceph]alexin** (Similar drugs: [cef]azolin, [cef]triaxone, [cef]epime) **Pharmacological Class** [Ceph]alosporin, beta-lactam antibiotic --------------------------- ------------------------------------------------------------------ **Indication** Broad spectrum, skin infections (i.e. Cellulitis) **Contraindication** Severe penicillin allergy (anaphylaxis) **Adverse Effects** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **Specials** Monitor if renal impairment or bleeding disorder **Meropenem** **Pharmacological Class** Carbapenem, beta-lactam antibiotic --------------------------- ------------------------------------------------------------------------------------ **Indication** Broad spectrum, Peritonitis, UTI **Contraindication** Severe penicillin allergy, Pregnancy **Adverse Effects** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **Specials** IV only **Aztreonam** **Pharmacological Class** Monobactam, beta-lactam --------------------------- -------------------------------------------------------------------------------- **Indication** UTI, Sepsis, Resp. Infections, Intra-abdominal infections, Surgical infections **Contraindication** Severe penicillin allergy, Renal and Liver disease **Adverse Effects** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **Specials** Parental administration (IV, IM) **Notes:** **[Clindamycin]** **Mechanism of action** Bacteriostatic (inhibits protein synthesis) ------------------------- ------------------------------------------------------------------------------------- **Indication** Skin infections, MRSA, Pneumonia, Dental Infections **Adverse Effects** C. Diff, \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **Specials** Monitor if renal disease, liver disease, or colitis **[Glycopeptide Antibiotics]** **Vancomycin** +-----------------------------------+-----------------------------------+ | **Mechanism of Action** | **Bactericidal** (Inhibits | | | bacterial cell wall synthesis) | +===================================+===================================+ | **Indication** | IV - Staph. Infections, MRSA | | | | | | Oral - C. Diff | +-----------------------------------+-----------------------------------+ | **Contraindication** | Allergy | +-----------------------------------+-----------------------------------+ | **Adverse Effects** | Phlebitis, Red Man Syndrome, | | | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ | | | _\_ | +-----------------------------------+-----------------------------------+ | **Specials** | IV use - monitor peak and trough | | | levels, administer slowly to | | | avoid red man syndrome, monitor | | | BUN / Creatinine, monitor hearing | | | acuity | +-----------------------------------+-----------------------------------+ **[Metronidazole]** **Mechanism of Action** Bactericidal (disrupts cellular DNA) ------------------------- --------------------------------------------------------------------------------------------------- **Indication** C. diff, protozoal infections (e.g. giardia, amoebiasis, trichomoniasis) **Contraindication** Alcoholism, seizure disorder, warfarin use **Adverse Effects** \_\_\_\_\_\_\_\_\_\_\_\_\_\_reaction if combined with alcohol, metallic taste, dry mouth, seizure **Specials** If client is on warfarin, monitor INR **Notes:** **[Sulfamethoxazole/Trimethoprim] (SMZ/TMP)** **Mechanism of Action** Bactericidal (Folic acid blocker) ------------------------- ------------------------------------------------------------------------------ **Indication** UTI, Pneumonia, Otitis Media **Contraindication** \_\_\_\_\_\_\_\_\_\_\_\_, Renal failure, Avoid in 1^st^ trimester **Adverse Effects** Steven-Johnsons Syndrome, C. Diff, bone marrow suppression, photosensitivity **Specials** Monitor / Report ANY skin rash while taking, avoid sun, Monitor CBC **[Nitrofurantoin]** **Mechanism of Action** Bacteriostatic (damages DNA) ------------------------- ----------------------------------------------------------------------- **Indication** Lower UTI (cystitis), recurrent UTIs **Contraindication** Renal disease, Avoid in \_\_\_\_\_\_\_\_\_ of pregnancy **Adverse Effects** Anorexia, bone marrow suppression, hypersensitivity reaction **Specials** Urine changes color (brownish), Tooth discoloration if chewed/crushed **[Fosfomycin]** **Mechanism of Action** Bactericidal (Inhibits bacterial cell wall synthesis) ------------------------- ------------------------------------------------------- **Indication** UTI **Contraindication** Renal and Liver disease **Adverse Effects** Headache, vaginitis, drowsiness **Specials** Single dose for lower UTI (cystitis) **[Phenazopyridine\*]** - \*NOT an antibiotic, but used to treat the pain associated with urinary tract infections **Therapeutic Class** Analgesic (Pain Reliever) ------------------------- ------------------------------------------------------------------------------- **Mechanism of Action** Local anesthetic in the bladder and urethral mucosa **Indication** Cystitis Pain (burning with urination, pain, frequency, urgency) **Contraindication** Renal disease **Adverse Effects** Discoloration of bodily fluids (Orange Red): this includes urine, tears, etc. **[Aminoglycoside Antibiotics]** **Gentamicin** (Similar drugs: tobramycin) **Mechanism of Action** Bactericidal (Disrupts protein synthesis) ------------------------- --------------------------------------------------------------------- **Indication** Gram -- infections, UTI, Intra-abdominal infections, conjunctivitis **Contraindication** Pregnancy, Renal Failure **Adverse Effects** Ototoxicity, Nephrotoxicity **Specials** Monitor peak and trough, monitor hearing acuity, Monitor creatinine **[Tetracycline Antibiotics]** **Tetracycline** (Similar drugs: doxycycline, minocycline) **Mechanism of Action** Bacteriostatic (Inhibits bacterial protein synthesis) ------------------------- --------------------------------------------------------------------------------------------------------- **Indication** Broad Spectrum, Acne vulgaris, Dental infections, STI (chlamydia), H. Pylori, Lyme Disease, PCN allergy **Contraindication** Pregnancy, Children under\_\_\_\_\_\_ years of age, Kidney and liver disease **Adverse Effects** Tooth discoloration, photosensitivity, esophageal ulceration, hepatotoxicity, supra-infection **[Fluoroquinolone Antibiotics]** **Ciprofloxacin** **Mechanism of Action** Inhibits DNA replication (bactericidal or bacteriostatic) ------------------------- --------------------------------------------------------------------------------------------------------- **Indication** Broad Spectrum, UTI, Pneumonia, Osteomyelitis, Soft tissue infection, Anthrax exposure **Contraindication** Clients under \_\_\_\_\_ years of age, Pregnancy, Use cautiously in Geriatrics, renal disease, warfarin **Adverse Effects** Supra-infection, Tendonitis / Rupture, Photosensitivity **Specials** Risk to Achille's Tendon rupture, Monitor INR if used with Warfarin **[Macrolide Antibiotics]** **Erythromycin** (Similar drugs: azithromycin) **Mechanism of Action** Bacteriostatic (Inhibits bacterial protein synthesis) ------------------------- -------------------------------------------------------------------------------------- **Indication** Strep throat, PCN allergy, Diphtheria, STI (Chlamydia) **Contraindication** QT Prolongation (or medications that cause it), Liver disease, Caution with warfarin **Adverse Effects** \_\_\_\_\_\_\_\_\_\_ and possible Torsade's de Pointe, GI upset\*, Ototoxicity **Specials** Monitor INR if used with Warfarin **Notes:** **Anti-Tubercular Antibiotics** - Tuberculosis requires 4-9 months of treatment with multiple antibiotics - Tuberculosis is caused by a mycobacterium, which is only susceptible to antibiotics that are specifically indicated for tuberculosis treatment +-------------+-------------+-------------+-------------+-------------+ | **Drug | **Mechanism | **Contraind | **Adverse | **Specials* | | Name** | of Action** | ications** | Effects** | * | +=============+=============+=============+=============+=============+ | **Isoniazid | Bactericida | Liver | Peripheral | Monitor for | | ** | l | disease | Neuropathy, | jaundice, | | | | | hepatotoxic | Liver | | | | | ity, | function | | | | | hyperglycem | test | | | | | ia | (LFTs), | | | | | | blood | | | | | | glucose (in | | | | | | diabetics) | | | | | | | | | | | | Co-administ | | | | | | er | | | | | | with | | | | | | Pyridoxine | | | | | | (Vit B6) to | | | | | | prevent | | | | | | neuropathy | +-------------+-------------+-------------+-------------+-------------+ | **Rifampin* | Bactericida | Renal or | Discolorati | Monitor | | * | l | Liver | on | Liver | | | | disease | of bodily | Function | | | | | fluids (red | Tests | | | | | orange), | (LFTs) | | | | | hepatotoxic | | | | | | ity, | | | | | | GI upset | | +-------------+-------------+-------------+-------------+-------------+ | **Ethambuto | Bacteriosta | Optic | Vision | Monitor | | l** | tic | neuritis, | impairment | visual | | | | renal or | and loss, | acuity | | | | liver | hepatotoxic | | | | | disease | ity | | +-------------+-------------+-------------+-------------+-------------+ **Name one adverse effect each for isoniazid, rifampin and ethambutol** **\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** **What monitoring is required for the adverse effects mentioned above?** **\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** **Notes:** **\ ** **Antifungal Medications\ ** Common causes of fungal infections - Reduced immunity due to HIV infection, chemotherapy, steroid use, diabetes mellitus - Indwelling catheter - Prolonged antibiotic use Superficial vs Deep Infection - Superficial: dermatophytes (tinea), yeast (candida) - Deep/Systemic: candida, aspergilla, mucormycosis, histoplasmosis **Ketoconazole** (Similar drugs: clotrimazole, fluconazole) +-----------------------------------+-----------------------------------+ | **Indication** | Fungal infections (Candida and | | | Tinea) | +===================================+===================================+ | **Contraindication** | Renal or liver disease | +-----------------------------------+-----------------------------------+ | | Hepatitis, Anti-androgen effects | | | (gynecomastia, erectile | | | dysfunction, irregular menses) | +-----------------------------------+-----------------------------------+ | | Monitor Liver Function Tests | | | (LFTs) | +-----------------------------------+-----------------------------------+ **Nystatin** **Indication** Candidiasis (Yeast infections): Oral / Vaginal, Denture soak --------------------- -------------------------------------------------------------- **Adverse Effects** GI upset: nausea, vomiting, diarrhea **Amphotericin B** **Indication** Severe systemic fungal infections ---------------------- -------------------------------------------------------------------------------- **Contraindication** Aminoglycoside **Adverse Effects** IV phlebitis, myelosuppression, infusion reaction, hypokalemia, nephrotoxicity **Specials** IV only **Antiviral Drugs** +-----------+-----------+-----------+-----------+-----------+-----------+ | **Drug | **Acyclov | **Gancicl | **Oseltam | **Interfe | **Ribavir | | Name** | ir** | ovir** | ivir** | ron** | in** | +===========+===========+===========+===========+===========+===========+ | **Mechani | Inhibit | **\*** | | | | | sm | viral DNA | | | | | | of | replicati | | | | | | Action** | on | | | | | +-----------+-----------+-----------+-----------+-----------+-----------+ | **Indicat | **\*** | Cytomegal | Influenza | \* | \* | | ion** | | ovirus | A | | | | | | (CMV) | | | | +-----------+-----------+-----------+-----------+-----------+-----------+ | **Contrai | Renal | Renal | | | | | ndication | disease | disease,\ | | | | | ** | (if | * | | | | | | administe | | | | | | | red | | | | | | | IV) | | | | | +-----------+-----------+-----------+-----------+-----------+-----------+ | **Adverse | If | Myelosupp | \* | | | | Effects** | administe | ression, | | | | | | red | | | | | | | IV: | impaired | | | | | | phlebitis | fertility | | | | | | , | | | | | | | nephrotox | | | | | | | ic | | | | | +-----------+-----------+-----------+-----------+-----------+-----------+ \*complete this section using your lecture video **HIV Antiretrovirals** Antiretroviral Drug Classifications - Entry/Fusion Inhibitors - Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) - Non-nucleoside/nucleotide reverse transcriptase inhibitors (NNRTIs) - Protease Inhibitors (PIs) HIV Treatment Regimens - Pre-exposure prophylaxis (PrEP): taken prior to exposure to prevent infection - 2NRTIs (emtricitabine-tenofovir) - Post-exposure prophylaxis (PEP): taken after exposure (ideally within 2 hours, but up to 72 hours) to prevent infection - 2 NRTIs + 1PI (emtricitabine-tenofovir + raltegravir) - Highly active antiretroviral therapy (ART/HAART): combines multiple anti-retroviral medications to lower viral load & prevent resistance **HIV Antiretrovirals** +-------------+-------------+-------------+-------------+-------------+ | **Drug | **Mechanism | **Contraind | **Adverse | **Specials* | | Name** | of Action** | ications** | Effects** | * | +=============+=============+=============+=============+=============+ | **Enfuvirti | Entry/Fusio | | Pneumonia, | Used for | | de** | n | | injection | HIV | | | Inhibitor | | site | TREATMENT | | | | | erythema | unresponsiv | | | \* | | | e | | | | | | to other | | | | | | antiretrovi | | | | | | rals | +-------------+-------------+-------------+-------------+-------------+ | **Efavirenz | Non-Nucleos | Allergy | Stevens-Joh | | | ** | ide/Nucleot | | nson | | | | ide | | syndrome, | | | | Reverse | | erythema | | | | Transcripta | | multiforme | | | | se | | | | | | Inhibitors | | | | | | (NNRTs) | | | | | | | | | | | | \* | | | | +-------------+-------------+-------------+-------------+-------------+ | **Lopinavir | Protease | Diabetes, | Hyperlipide | Monitor | | /ritonavir* | Inhibitors | heart | mia, | blood | | * | (PIs) | disease, | \*\_\_\_\_\ | sugar, bone | | | | osteoporosi | _\_\_\_\_, | health | | | \* | s | osteoporosi | | | | | | s, | | | | | | GI upset | | +-------------+-------------+-------------+-------------+-------------+ | **Tenofovir | Nucleoside/ | | Dizziness, | Can be used | | ** | Nucleotide | | nausea, | in | | | Reverse | | diarrhea | combination | | | Transcripta | | | with other | | | se | | | medicines | | | Inhibitors | | | in PrEP and | | | (NRTIs) | | | PEP | | | | | | | | | \* | | | | +-------------+-------------+-------------+-------------+-------------+ \*complete the chart using your lecture videos **Notes:** **\ ** **Module 3---**Week 3 **Module 3 Topics //** Immunomodulators & Antineoplastic Agents **Bone Marrow Suppression (a.k.a. myelosuppression)** -- reduction in cells produced by the bone marrow - Red blood cells (anemia) -- reduction leads to fatigue, paleness, falls - White blood cells (leukopenia, neutropenia) -- reduction leads to fever, cough, infection - Platelets (thrombocytopenia) -- reduction leads to bleeding, petechia, bruising **Infection/Neutropenic Precautions** - Report fever (38.3^O^C/ 100.94^O^F) - Report changes in baseline blood pressure - Report signs of infection - Wash hands and moisturize to prevent cracked skin - Avoid crowds - Do not eat raw food (including vegetables) - Avoid activities that could cause exposure to pathogens - Adhere to medication schedules and laboratory visits - Avoid pregnancy **Immunostimulants** **Interferon alfa-2b** **Mechanism of Action** Activates immune signals to protect against viral infections ------------------------- -------------------------------------------------------------- **Indication** Viral infections (Hep B/ Hep C), certain cancers **Adverse Effects** Bone marrow suppression, flu-like illness, hair loss **Specials** Administered IM or IV, Monitor CBC **Aldesleukin (Interleukin 2)** **Therapeutic Class** Antineoplastic Agent ------------------------- --------------------------------------------------------------------------------------------------------------------- **Mechanism of Action** Regulates WBC activity, increases T and B cell activity **Indication** Metastatic renal cancer, metastatic malignant melanoma, lymphoma, leukemia **Adverse Effects** Flu-like illness, anemia, thrombocytopenia, rash, low BP, diarrhea, capillary leak syndrome, hepatitis, oral ulcers **Specials** Administered IV or SC, Monitor CBC, Monitor platelets **Name three neutropenic precautions** **\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** **Name three symptoms of bone marrow suppression** **\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** **Notes:\ ** **Immunosuppressants** **Cyclosporine** (Similar Drugs: tacrolimus) **Mechanism of Action** Calcineurin inhibitor ------------------------- -------------------------------------------------------------------------------------------------------- **Indication** Prophylaxis for organ transplant rejection, graft vs host disease, autoimmune/inflammatory conditions, **Contraindication** Uncontrolled HTN, pregnancy **Adverse Effects** Increased risk of cancers (lymphoma), increased risk of infection, HTN, fevers **Specials** Lifelong treatment: adherence risk, monitor renal / hepatic function, monitor blood levels **Azathioprine** (Similar Drugs: mercaptopurine) **Mechanism of Action** Inhibit RNA synthesis (DNA damage / chromosome breakdown) ------------------------- ---------------------------------------------------------------------------------------------------- **Indication** Prophylaxis for organ transplant rejection, autoimmune disease, inflammatory bowel disease (IBS) **Contraindication** Liver disease **Adverse Effects** Liver toxicity, bone marrow suppression, fatigue, vomiting, increased risk of cancer/lymphoma **Specials** Lifelong treatment: adherence risk, monitor liver function (LFTs), Monitor CBC, Avoid immunization **Monoclonal Antibodies** - Examples (end in '-mab'): basiliximab, adalimumab, infliximab **Mechanism of Action** Inhibits T cell activation preventing proliferation ------------------------- --------------------------------------------------------------- **Indication** Prophylaxis of transplant rejection **Contraindication** Previous drug use, geriatrics, pregnancy **Adverse Effects** Allergic reaction, flu-like illness, vomiting, diarrhea, rash **Specials** Monitor infusion reaction, CBC, platelets, and skin health **Immunizations** **Live attenuated vaccines:** contain a weakened version of the pathogen - Examples: Contraindications to vaccine administration: - Previous anaphylactic reaction to the vaccine or any component of the vaccine - Currently ill - History of Guillain-Barre Syndrome - **Immunocompromised (avoid live vaccines)** - Pregnancy (avoid live vaccines) **[Common adverse effects of immunizations]: injection site reactions (tenderness, redness, swelling), low fever (37.8^O^C/100^O^F), irritability, drowsiness, malaise, anorexia, headache** **[Tetanus Vaccines]** - Contraindications: encephalopathy, Guillain-Barre Syndrome **Vaccine** **Coverage** **Who?** **When?** ------------- ------------------------------------------------------------- --------------------------------------- -------------------------------------------------------------------------------------------------------------- **DTaP** Diphtheria, tetanus, & acellular pertussis (whooping cough) Children 2, 4, and 6 months followed by a dose at 15-18 months then 4-6y **Tdap** Tetanus, diphtheria, & acellular pertussis Adults/ adolescents, pregnancy women 11-12y, 19y, Pregnant Women: 27-36wks **Td** Tetanus & diphtheria Adults who have already received Tdap Every 10 years after receiving Tdap (if exposed to tetanus administer if last dose \>5 years ago or unknown) **[Vaccines]** - **Avoid live vaccines in which type of patient? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** +-----------+-----------+-----------+-----------+-----------+-----------+ | **Vaccine | **Who** | **When** | **Adverse | **Contrai | **Caution | | ** | | | Effects** | ndication | s** | | | | | | ** | | +===========+===========+===========+===========+===========+===========+ | **Hemophi | Children | 2 and 4 | | | | | lus | \> 6 | months, | | | | | Influenza | months | with | | | | | e | old | possibili | | | | | Type B | | ty | | | | | (Hib)** | | of dose | | | | | | | at 6 | | | | | | | months | | | | | | | followed | | | | | | | by 12-18 | | | | | | | months | | | | +-----------+-----------+-----------+-----------+-----------+-----------+ | **Seasona | Children | Annually | Injection | History | | | l | \> 6 | | site | of | | | Influenza | months | | tendernes | Guillain- | | | ** | old, | | s, | Barre | | | | Adults, | | fever, | syndrome, | | | | Pregnant | | malaise, | egg | | | | Women, | | hoarsenes | allergy | | | | Immunocom | | s, | | | | | promised | | cough | | | +-----------+-----------+-----------+-----------+-----------+-----------+ | **Rotavir | Children | RV-1: (2 | Temporary | History | Chronic | | us** | | & 4 | diarrhea | of | GI | | | | months); | / | intussusc | disease, | | | | RV-5: (2, | vomiting, | eption, | spina | | | | 4, & 6 | irritabil | severe | bifida, | | | | months) | ity, | combined | bladder | | | | | intussusc | immunodef | exstrophy | | | | | eption | iciency | , | | | | | | (SCID) | immunocom | | | | | | | promised | | | | | | | status | +-----------+-----------+-----------+-----------+-----------+-----------+ | **Poliovi | Children | 2, 4 and | | History | | | rus | | 6-18 | | of | | | (IPV)** | | months, | | allergic | | | | | followed | | reaction | | | | | by 4-6y | | (anaphyla | | | | | | | xis) | | | | | | | to | | | | | | | neomycin, | | | | | | | streptomy | | | | | | | cin, | | | | | | | polymyxin | | | | | | | B | | +-----------+-----------+-----------+-----------+-----------+-----------+ | **Measles | Children | (12-15 | Mild | | History | | , | | months) | (rash, | | of | | Mumps, | | 4-6y | fever, | | thrombocy | | and | | | swollen | | topenia, | | Rubella | | | check/nec | | allergic | | (MMR)** | | | k | | reaction | | | | | nodes), | | to eggs, | | | | | Moderate | | gelatin, | | | | | (joint | | neomycin | | | | | pain, | | | | | | | stiffness | | | | | | | , | | | | | | | febrile | | | | | | | seizure, | | | | | | | thrombocy | | | | | | | topenia) | | | +-----------+-----------+-----------+-----------+-----------+-----------+ | **Varicel | Children | (12-15 | Injection | Pregnancy | | | la** | | months) | site | , | | | | | 4-6y, OR | tendernes | Immunocom | | | **(chicke | | 13+ (2 | s, | promised | | | n | | doses, 4 | fever, | (includin | | | pox)** | | wks. | rash, | g | | | | | apart) | seizure | concurren | | | | | | | t | | | | | | | use with | | | | | | | chemother | | | | | | | apy, | | | | | | | immunomod | | | | | | | ulators, | | | | | | | antiviral | | | | | | | s), | | | | | | | Allergic | | | | | | | reaction | | | | | | | to | | | | | | | gelatin | | | | | | | or | | | | | | | neomycin, | | | | | | | chemother | | | | | | | apy | | | | | | | patients | | +-----------+-----------+-----------+-----------+-----------+-----------+ | **Pneumoc | Children | 2, 4, and | | | | | occal | | 6 months | | | | | (PCV13)** | | followed | | | | | | | by 12-18 | | | | | | | months | | | | +-----------+-----------+-----------+-----------+-----------+-----------+ | **Hepatit | Children | 12-23 | | Latex | | | is | | months | | allergy | | | A** | | (followed | | | | | | | by 2^nd^ | | | | | | | dose at | | | | | | | 6-18 | | | | | | | months | | | | | | | after | | | | | | | 1^st^ | | | | | | | dose) | | | | +-----------+-----------+-----------+-----------+-----------+-----------+ | **Hepatit | Children | Birth, | | Anaphylax | Low body | | is | | 1-2 | | is | weight | | B** | | months, | | to yeast | (less | | | | 6-18 | | | than 2kg) | | | | months | | | | +-----------+-----------+-----------+-----------+-----------+-----------+ | **Meningo | Adolescen | 11-12y | | | | | coccal | ts | with | | | | | (MCV4)** | | booster | | | | | | | at 16y | | | | +-----------+-----------+-----------+-----------+-----------+-----------+ | **Human | Adolescen | 11-12y | Injection | Pregnancy | | | Papilloma | ts | (with 2 | site | , | | | virus | (best | doses | tendernes | Anaphylax | | | (HPV)** | before | separated | s, | is | | | | 1^st^ | by 12 | fever, | to yeast | | | | sexual | months), | fainting | | | | | encounter | up to age | around | | | | | ) | 26y | time of | | | | | | | administr | | | | | | | ation | | | +-----------+-----------+-----------+-----------+-----------+-----------+ | **Herpes | Adults | Age 50+ | | Allergic | | | Zoster | | (2 doses | | response | | | (Shingrix | | spaced | | to | | | )** | | 2-6months | | previous | | | | | apart), | | dose | | | | | 19y + in | | | | | | | immunocom | | | | | | | promised | | | | | | | persons | | | | +-----------+-----------+-----------+-----------+-----------+-----------+ | **COVID** | 6 months | Boosters- | malaise, | | | | | to 17 | refer to | fever, | | | | | years | CDC | headache, | | | | | (mRNA or | guideline | anaphylax | | | | | subunit | s | is, | | | | | only), | | myocardit | | | | | 18+ (any) | | is/perica | | | | | | | rditis | | | +-----------+-----------+-----------+-----------+-----------+-----------+ **Immunoglobulins** **What is immunoglobulin and how does it differ from an immunization?** **\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** **\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** **RhoGAM** **Who** Pregnancy ---------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- **Why** To prevent maternal Rh^-^ antibodies from forming an immune response to Rh^+^ fetal blood cells (Most important for the 2^nd^ (or more) Rh+ fetus, compared to the 1^st^) **How** Administered into the pregnant client, RhoGAM will bind to any fetal Rh^+^ within maternal circulation and prevent maternal antibodies from attaching and destroying that RBC **Contraindication** Fetal Rh^-^, Maternal Rh^+^ **Cautions** Prophylaxis at 28wks gestation **Name three examples of live vaccines** **Notes:\ ** **Antineoplastic Agents\ ** **[Cytotoxic Chemotherapy Agents:]** **Neutropenic Precautions:** - Bathe daily - Brush teeth daily and sterilize your toothbrush - Prevent constipation - Report signs of illness - Avoid tampons and douches - Do not share personal items - Avoid live plants/flowers and standing water - Wash hands and moisturize to prevent cracked skin - Do not each raw foods, including vegetables and sushi - Refrigerate food immediately - Seek medical attention is fever of 101.0^O^F (38.3^O^C) or higher once OR 100.4^O^F (38^O^C) for ≥1 hr. **Common adverse effects:** bone marrow suppression & immunosuppression (increased risk of infection), nausea/vomiting, diarrhea, stomatitis/oral mucositis (sore/inflamed mouth), alopecia (hair loss) **Cyclophosphamide** (Similar Drugs: chlorambucil, cisplatin) **Indication** Hodgkin's and non-Hodgkin's lymphomas, acute / chronic leukemias, ovarian / breast cancers, multiple myeloma, sarcoma, neuroblastoma, retinoblastomas ---------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------- **Contraindication** Severe bone marrow suppression, lactation, pregnancy **Adverse Effects** Hemorrhagic cystitis, hematuria, hepatotoxicity **Mesna** **Therapeutic Class** Cytoprotective drugs ------------------------- -------------------------------------------------------------------------------- **Mechanism of Action** Binds to toxic metabolites in urinary bladder **Indication** Hemorrhagic cystitis & hematuria associated with cyclophosphamide chemotherapy **Adverse Effects** Hypokalemia, thrombocytopenia, tachycardia, hypotension, fatigue, fever **Methotrexate** **Indication** Osteosarcoma, acute leukemia, breast cancer, lung cancer, severe rheumatoid arthritis, pregnancy termination with misoprostol --------------------- ------------------------------------------------------------------------------------------------------------------------------- **Adverse Effects** Hepatotoxicity, ulcerative stomatitis, bleeding (bowels), teratogenic **Specials** Drink plenty of fluids, neutropenic precautions, avoid NSAIDs **Leucovorin (Folinic Acid)** (Similar Drugs: folic acid) **Therapeutic Class** Methotrexate rescue ------------------------- ---------------------------------------------------- **Mechanism of Action** Adds folic acid to reverse methotrexate effects **Indication** Treats bone marrow suppression due to methotrexate **Doxorubicin** (Similar Drugs: epirubicin, daunorubicin) **Indication** Neuroblastoma, solid tumors (bone, bladder, breast, ovary, GI tract, lung, thyroid), acute leukemias, multiple myeloma, Kaposi's sarcoma ---------------------- ------------------------------------------------------------------------------------------------------------------------------------------ **Contraindication** Cardiac disease, pregnancy, lactation, bone marrow suppression, obstructive jaundice **Adverse Effects** Congestive heart failure, rash, mucositis, temporary discolored urine, vesicant **Specials** Monitor CBC, neutropenic precautions, Lifetime limit, LFTs, ECG monitoring **Vincristine** (Similar Drugs: vinblastine) **Indication** Acute leukemia, lymphoma, malignant glioma, neuroblastoma, sarcoma, Wilms's tumor, breast cancer ---------------------- -------------------------------------------------------------------------------------------------- **Contraindication** Obstructive jaundice, childbearing age, active infection **Adverse Effects** Neurotoxicity, anorexia, stomatitis, mild bone marrow suppression, hyponatremia, vesicant **Specials** Monitor for neuropathies **Hydroxyurea** **Indication** Myelogenous leukemia, ovarian cancer, squamous cell cancer --------------------- ---------------------------------------------------------------------------- **Adverse Effects** Hypersensitivity, CNS effects, hepatotoxic, pancreas toxicity, renal toxic **Specials** Monitor CBC, neutropenic precautions **Doxorubicin has a lifetime maximum dose, explain why.** **Name two side effects of vincristine.** **\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** **Notes:** **[Targeted Antineoplastic Agents:]** **Tamoxifen** (Similar Drugs: raloxifene) +-----------------------------------+-----------------------------------+ | **Mechanism of Action** | Selective estrogen receptor | | | modulator (SERM) | | | | | | Binds estrogen receptors causing | | | anti-estrogen effects | +===================================+===================================+ | **Indication** | Breast cancer (treatment / | | | prevention) | +-----------------------------------+-----------------------------------+ | **Contraindication** | Pregnancy, lactation, history of | | | DVT/PE | +-----------------------------------+-----------------------------------+ | **Adverse Effects** | Menopausal symptoms (hot flashes, | | | irregular menses, vaginal | | | bleeding/discharge), increased | | | risk of DVT/PE, cataracts, | | | reduced libido | +-----------------------------------+-----------------------------------+ | **Specials** | Monitor for thromboembolism | +-----------------------------------+-----------------------------------+ **Trastuzumab** **Mechanism of Action** Inhibits HER2 mediated cell growth ------------------------- ----------------------------------------------- **Indication** Breast cancer (HER2 positive), stomach cancer **Contraindication** Cardiac disease **Adverse Effects** Flu-like symptoms, cardiac dysfunction **Specials** Monoclonal antibody **In addition to the adverse effects listed on all the above drug monographs. What are the common adverse effects of antineoplastic agents?** **Name the cytoprotective medication given with cyclophosphamide.** **\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** **Notes:** **\ ** **Module 4---**Week 4 **Module 4 Topics //** Pain & Substance Abuse **Pain Management** - Start with non-pharmacological interventions - Listen to the client - Dosing should be individualized and adjusted as needed - Reduce pain to allow for tasks of daily living - Pain management is a patient right - Patient controlled analgesia (PCA) infusion pump -- a system where the client presses a button to administer analgesic medication (typically opioid) to treat pain - Used in post-surgical palliative care - Client receives baseline amount per hour with the ability to add more for breakthrough pain (hourly max) **Term** **Definition** ------------ ---------------- Adjuvant Tolerance Dependence Withdrawal **Neuropathic Pain\ ** **Duloxetine** **Therapeutic Class** Antidepressants ------------------------- ------------------------------------------------------------------------------------------------------ **Mechanism of Action** \* **Indication** Diabetic peripheral neuropathy pain, fibromyalgia, chronic musculoskeletal pain, depression, anxiety **Contraindication** Renal or liver disease, recent MAOI use **Adverse Effects** Drowsiness, blurred vision, insomnia, sexual dysfunction, risk of serotonin syndrome **Specials** Possible withdrawal syndrome: headache, visual disturbance, anxiety, tremors) Taper **Pregabalin** **Therapeutic Class** Anticonvulsant ------------------------- ----------------------------------------------------------------------------------------- **Mechanism of Action** Enhances GABA effects, reduces seizure activity **Indication** Neuropathic pain, fibromyalgia, restless leg syndrome, seizures, epilepsy **Contraindication** Caution in pregnancy **Adverse Effects** Somnolence, impaired cognition, blurry vision, weight gain, peripheral edema, dry mouth **Amitriptyline** **Therapeutic Class** Antidepressant (tricyclic) ------------------------- ----------------------------------------------------------------------------------------- **Mechanism of Action** Inhibits re-uptake of norepinephrine and serotonin **Indication** Fibromyalgia, chronic pain, depression, insomnia **Contraindication** Seizures, urinary/bowel retention, BPH, glaucoma, hyperthyroidism **Adverse Effects** Anticholinergic effects, sedation, decreased seizure threshold, orthostatic hypotension **What is the difference between amitriptyline and duloxetine?** **\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** **Nociceptive Pain** **Non-Opioid Analgesics** **Acetaminophen** +-----------------------------------+-----------------------------------+ | **Therapeutic Class** | Analgesic (NOT an NSAID) | +===================================+===================================+ | **Indication** | Mild pain, fever | +-----------------------------------+-----------------------------------+ | **Contraindication** | Severe liver disease, chronic | | | alcohol use | +-----------------------------------+-----------------------------------+ | **Adverse Effects** | Complications rare if taking | | | appropriate dose | | | | | | Acute liver toxicity: | | | nausea/vomiting/diarrhea, | | | sweating, abdominal discomfort | | | liver failure, coma, death | +-----------------------------------+-----------------------------------+ **Amitriptyline** **Therapeutic Class** Antidepressant (tricyclic) ------------------------- ----------------------------------------------------------------------------------------- **Mechanism of Action** Inhibits re-uptake of norepinephrine and serotonin **Indication** Fibromyalgia, chronic pain, depression, insomnia **Contraindication** Seizures, urinary/bowel retention, BPH, glaucoma, hyperthyroidism **Adverse Effects** Anticholinergic effects, sedation, decreased seizure threshold, orthostatic hypotension **What are the "anticholinergic effects"?\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** **Hydroxyzine** **Therapeutic Class** Antihistamine ------------------------- -------------------------------------------------------------------------- **Mechanism of Action** Analgesia (high dose), competes with histamine **Indication** Sedation, pruritis **Contraindication** Asthma, 1^st^ trimester pregnancy, breastfeeding **Adverse Effects** Respiratory depression, injection site tenderness, drowsiness, dry mouth **Specials** Reduced dose in geriatric care **Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)** - All are nephrotoxic - All increase the risk of bleeding (e.g., GI bleeds) **Aspirin** (a salicylate) +-----------------------------------+-----------------------------------+ | **Therapeutic Class** | NSAID (Antiplatelet) | +===================================+===================================+ | **Mechanism of Action** | Reduces prostaglandin signaling | | | by inhibiting COX 1 and COX 2 | | | enzymes | +-----------------------------------+-----------------------------------+ | **Indication** | Inflammatory suppression, mild to | | | moderate pain, fever, | | | anti-platelet blood thinner | +-----------------------------------+-----------------------------------+ | **Contraindication** | Pregnancy, hypertension, bleeding | | | disorders, children under 19 who | | | have viral illness, surgery, | | | asthmatics | +-----------------------------------+-----------------------------------+ | **Adverse Effects** | Salicylism (tinnitus, sweating, | | | headache, dizziness) | | | | | | Reye Syndrome (Rare): vomiting, | | | brain dysfunction, seizures | +-----------------------------------+-----------------------------------+ | **Specials** | Effects are irreversible *(have | | | to wait it out)* | +-----------------------------------+-----------------------------------+ **Ibuprofen** **Therapeutic Class** NSAID ------------------------- ------------------------------------------------------------------------------------------------------ **Mechanism of Action** Reduces prostaglandin signaling by inhibiting COX 1 and COX 2 enzymes **Indication** Inflammatory suppression, mild to moderate pain, fever, arthritis **Contraindication** Hypertension, peptic ulcer disease, bleeding disorders, aspirin use, ACEIs/ARBs use, asthmatics **Adverse Effects** GI discomfort, impaired kidney function, hypertension, heart attack, peptic ulcer disease (GI bleed) **Celecoxib** **Therapeutic Class** **NSAID (Selective COX 2 inhibitor)** ------------------------- -------------------------------------------------------------------------------------- **Mechanism of Action** **Reduces prostaglandin signaling by selectively inhibiting COX 2 enzymes** **Indication** **Inflammatory suppression, mild to moderate pain, fever** **Contraindication** **Clients at risk of MI/stroke, sulfonamide allergy, asthmatics, ACEIs/ARBs use** **Ad
