Pharmacy Exam 6 PDF

Fat Soluble Vitamins o Vitamins A,D,E,K o High risk of toxicity since they are stored in the body for a long time o Vitamin A § Retinol § Vision health; skeletal and soft tissue development/ strength § Foods: orange/yellow fruits a...

Fat Soluble Vitamins o Vitamins A,D,E,K o High risk of toxicity since they are stored in the body for a long time o Vitamin A § Retinol § Vision health; skeletal and soft tissue development/ strength § Foods: orange/yellow fruits and veggies, fatty fish, effs, liver, dairy products § Deficiency- vision issues, xeropthalmia (dry/ thickened conjunctive and cornea) o Vitamin D compounds § Calcitriol, ergocalciferol § USE: hypocalcemia; vitamin D deficiency; 2 percent hyperparathyroidism § AE: s/s of hypercalcemia; bone pain § FOODS: canned fish, cereals, fish fortified milk § DEFICINEY: rickets; osteomalacia o Vitamin E § Tocopherols § Antioxidant (protects cells from damage) § Foods: vegetable oil; nuts; whole grains; dark green vegetables § Deficiency: rare; muscle pain; weakness/poor balance (neuro); anemia o Vitamin K § Phytonadione § Blood clotting, bone maintenance § Foods: dark green/ green vegetables; eggs; fish; liver § Deficiency: increased bleeding time § ANTIDOTE FOR WARFARIN Water soluble vitamins o Vitamin C § ascorbic acid § Tissue building; metabolism; iron absorption § Foods: citrus fruits; tomatoes; green leafy vegetables; peppers § Deficiency: scurvy (bleeding, joint pain, swollen gums); poor wound healing § Increase intake during times of stress/illness o B-Complex vitamins § Metabolism; energy; nerve functioning § Foods: meats; milk; legumes; enriched grains; whole grains; green leafy vegetables § Thiamin (B1) Liver dx; alcohol abuse Deficiency: beriberi (impairment of nerves and heart); common in alcohol abuse § Niacin (B3)  High doses used to treat hyperlipidemia Deficiency: pellagra (dermatitis; diarrhea; dementia; death) § Riboflavin (B2) deficiency: chelosis (cracking at corners of mouth); glossitis (smooth/swollen red tongue) § folate; folic acid (B9) tx anemia; prevent neural tube defects; alcohol abuse; strict vegans deficiency: fetal neural tube defects; CNS disturbances § cyanocobalamin; cobalamin (B12) tx of pernicious anemia; B12 deficiency strict vegans or those lacking intrinsic factors § pyridoxine (B6) deficiency: CNS disturbances Trace minerals o Ferrous sulfates; iron dextran § Treat iron deficiency anemia § MOA: essential component of hemoglobin, myoglobin § SE: oral- GI upset; constipation teeth straining (use straw); dark green/ black stools (harmless) IM/ IV- staining at IV site (use z-track); hypotension; flushing; anaphylaxis § KEY POINTS: take with vitamin c (increase absorption); calcium (decrease absorption); take on empty stomach; increase fluid, fiber, and exercise o IRON- used to make hemoglobin (component of RBC) o Foods: meat, fish, grains, legumes o Keep out of reach of children due to fatal toxicity o Iodine § Used in synthesis of thyroxine (thyroid hormone) § Foods: table salt; seafood o Fluoride § Protects against cavities § Source: water o Zinc § Immune function § Foods: nuts, meat, beans, fortified cereal Dosage calc: weight based, IV infusion, IMI injection, IV push Overview of abx therapy o Obtain specimen for C&S (culture and sensitivity) before initiating therapy o Do not delay initiation of abx therapy; give within 1 hour o Watch for allergic reactions; treat with epinephrine and antihistamines § Anaphylactic response s/s- laryngeal edema; wheezing; pruitis; hypotension  o C&S determine MIC (minimum inhibitory concentration) which is the lowest drug concentration that inhibits cell growth; pick the drug with the lowest drug and still kills bacteria o Superinfections s/s- vaginal itching/discharge; thrush; diarrhea (bloody/mucus); development of new infection while on therapy for initial infection ( ex. Candidias; c-diff; pseudomonas colitis Prophylactic v. empiric therapy o Prophylactic- patient doesn’t have anything wrong with them; used to help reduce the risk; ex. Patient is having heart surgery but also has poor dental health o Empiric- treating with meds that covers most infections; patient has problem Antituberculins o “RIPE” o Isoniazid (INH); pyrazine inde; ethambutol o USES: tx mycobacterium and TB infections o MOA: inhibits mycobacterial cell wall synthesis and interferes with metabolism (can’t replicate or function) o SE: peripheral neuropathy; hepatotoxicity; hyperglycemia o KEY POINTS § Administer pyridoxine to decrease r/o or tx peripheral neuropathy § Monitor LFTs and s/s of liver failure § Avoid alcohol § Monitor BG § Avoid tyramine rich roods Rifampin o USES: tx gram negative and positive bacteria; combines with at least 1 anti- tuberculin meds to prevent abx resistance o MOA: bactericidal o SE: orange discoloration of body fluids; hepatotoxicity; GI discomfort; pseudomembranous colitis o KEY POINTS § Increase r/o hepatotoxicity when combines with other anti-tuberculin meds § Use non-hormonal form of BC Antivirals o “vir”; acyclovir; ganciclovir; oseltamivir; boceprevir; telaprevir; interferonalfa-2b; mainvudine; ribavirin; amantadine o USES: HSV; varicella-zoster; CMV; influence A and B; RSV; Heb C o MOA: prevent reproduction of viral DNA o SE: phlebitis at infusion site; nephrotoxicity> acyclovir; BMS (ganciclovir); fever; h/a; nausea; diarrhea o KEY POINTS § Use non-hormonal form of BC  § Genital lesions-use condoms/ refrain from sexual contact § Wear gloves when applying topical meds to avoid transfer of virus to other areas of the body Antiretroviral o CCRF antagonist: maravirox; fusion/entry inhibitors: enfuvirtide o NRTIs: zidovudine; didanosine; stavudine; lamivudine; abacavir o NNRTIs: delavirdine; efavirine; rilpiririne o Proteases inhibitors: ritonavir; saquinavir; indinavir; fozamprenavir; nelfinavir o Integrase inhibitors: raltegravir o USES: tx HIV infections o MOA: reduce viral load (decrease r/o transmission) o KEY POINTS § HAART ( highly active antiretroviral therapy) § Use of 3-4 HIV meds to decrease med resistance, AEs, dosage § Goal is to decrease amount of virus and increase CD4 counts § Missed doses increase r/o med resistance § Use condoms; do not share needles; do not donate blood Vancomycin o Typical dose 1 gram o Optimal blood levels of vancomycin are a trouble level of 10-20 mcg/mL o Trough levels- right before you give the next dose of medication o NARROW TGHERAPEUTIC INDEX o USES: staphylococcal infections; C-diff (oral dose) o MOA: binds to bacterial cell wall, resulting in cell death o SE: ototoxicity; nephrotoxicity; vancomycin flushing syndrome ( with rapid infection); SJS; phlebitis; hypotension; GI distress; hypersensitivity rxn o KEY POINTS § Observe for s/s of anaphylaxis § Monitor renal function throughout therapy § Monitor peak and through drug levels § monitor VS and IV site throughout therapy § Administer IV dose over 60-90 min to prevent “red-man” syndrome Drugs for UTIs Sulfonamides and trimethoprim o Trimethoprim-sulfamethoxazole; sulfadiazine o USES: UTIs; otitis media, PCP (pneumocystis jirovecii pneumonia); traveler’s diarrhea; shigella o MOA: bactericidal; inhibit the metabolism of folic acid in bacteria o SE: hypersensitivity rxn; blood dyscrasias; SJS; suprainfection; crystalluria; increase potassium; decrease sodium; kernicterus in neonates o KEY POINTS  § Assess for allergy to sulfa drugs, thiazide diuretic, sulfonylureas, or loop diuretics § Monitor CBC; report bleeding/sore throat/ pallor § UOP should be at least 1200-1500 mL/ daily § Do not give to pregnant women or infants less than 2 months Urinary Tract Antiseptics o Nitrofurantoin; methenamine o USES: tx acute UTIs; prophylaxis for recurrent UTIs o MOA: bacteriostatic and bactericidal; interferes with bacterial enzymes o SE: GI discomfort; hypersensitivity rxn; blood dyscrasias; peripheral neuropathy; pneumonitis pulmonary fibrosis o KEY POITNS § Monitor CBC; report bleeding/sore throat/ pallor § Administer with milk/ meals § Assess for s/s of pulmonary rxn § Do not give during 3rd trimester of pregnancy § Can turn urine rust-yellow to brown and can stain teeth Tetracyclines o “cycline”; tetracycline; doxycycline; minocycline; demeclocycline o USES: acne; anthrax; lyme dx; H. pylori; chlamydia; pneumonia o MOA: inhibit bacterial protein synthesis o SE: SJS (rash); Cdiff; hepatotoxicity (alcoholic liver disease; fatty acid-liver disease); phlebitis; pancreatitis; hypersensitivity rxn; GI distress (take with food); photosensitivity; discoloration, hypoplasia of tooth enamel o KEY POINTS: § observe for s/s of anaphylaxis § observe for s/s of C-doff § avoid use (IV) in children