Pharm Notes PDF

**Condition** **Common Pathogens** Otitis Media Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis Otitis Externa Pseudomonas aeruginosa, Staphylococcus aureus Bacterial Pharyngitis Group A Streptococcus (Streptococcus pyogenes) Acute Bacterial Sinusitis Streptococcus p...

**Condition** **Common Pathogens** Otitis Media Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis Otitis Externa Pseudomonas aeruginosa, Staphylococcus aureus Bacterial Pharyngitis Group A Streptococcus (Streptococcus pyogenes) Acute Bacterial Sinusitis Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis Dental Infection Streptococcus mutans, Streptococcus viridans, anaerobes Condition First-Line Treatment Second-Line (PCN Allergy) --------------------------- ---------------------------------------- ----------------------------- Acute Otitis Media Amoxicillin Azithromycin or Clindamycin Otitis Externa Ciprofloxacin/dexamethasone otic drops Oral Ciprofloxacin Bacterial Pharyngitis Penicillin or Amoxicillin Azithromycin or Clindamycin Acute Bacterial Sinusitis Amoxicillin-clavulanate Doxycycline or Levofloxacin Dental Infection Amoxicillin or Amoxicillin-clavulanate Clindamycin or Azithromycin **Natural Immunity**: Innate immune response involving physical barriers (e.g., skin, mucosa), phagocytes, and natural killer cells. **Cell-Mediated Immunity**: T cells (CD4+ helper, CD8+ cytotoxic) recognize and destroy infected cells or pathogens directly. **Antibody-Mediated Immunity**: B cells produce antibodies that neutralize pathogens and promote their clearance by phagocytes. **Synthesis**: Produced in the adrenal cortex under ACTH stimulation from the pituitary. **Secretion**: Regulated by the hypothalamic-pituitary-adrenal (HPA) axis and circadian rhythms. **Effects**: Reduce inflammation, suppress immune response, increase gluconeogenesis, and regulate blood pressure. - **Adults**: Administer intramuscular epinephrine (0.3-0.5 mg IM), repeat every 5-15 minutes if needed. - **Children**: Administer epinephrine (0.01 mg/kg IM, max 0.3 mg), repeat as required. - Supportive care: Oxygen, IV fluids, antihistamines (diphenhydramine), and corticosteroids. **Mechanism of Action**: Stimulates alpha (vasoconstriction) and beta (bronchodilation, increased cardiac output) receptors. **Pharmacokinetics**: Rapid absorption via IM injection; short half-life ensures quick onset and offset of action. **Adverse Effects** **Oral Administration** **Topical Administration** --------------------------- -------------------------------------------------- --------------------------------------------------- Tachycardia, hypertension Taken for systemic effects (e.g., decongestants) Avoid prolonged use to prevent rebound congestion **First-Line Agents** **Second-Line Agents** ------------------------------------------- ------------------------------- Prostaglandin analogs (e.g., Latanoprost) Beta-blockers (e.g., Timolol) Alpha-2 agonists (e.g., Brimonidine) Carbonic anhydrase inhibitors **Condition** **Preferred Antidepressant** ----------------------- ------------------------------------- Fatigue Bupropion (activating) Insomnia Mirtazapine (sedating) Sexual Dysfunction Bupropion or Mirtazapine Chronic Pain Duloxetine or Amitriptyline Concomitant Diagnosis SSRI or SNRI depending on condition - **Children/Adolescents**: Fluoxetine (FDA-approved for adolescents). - **Adults**: SSRIs (e.g., Sertraline, Escitalopram). - **Older Adults**: Avoid TCAs; consider SSRIs with fewer interactions. - **Positive Symptoms**: Hallucinations, delusions, disorganized speech. - **Negative Symptoms**: Flat affect, anhedonia, social withdrawal. - **Etiology**: Dopamine dysregulation, genetic predisposition, environmental triggers. **1st Generation** **2nd Generation** ----------------------------- --------------------------------------------- High potency: Haloperidol Lower extrapyramidal symptoms: Aripiprazole Low potency: Chlorpromazine Metabolic side effects: Olanzapine **Type** **Features** **Management** ---------- ----------------------------------- -------------------------------------------------------- Early Dystonia, akathisia, parkinsonism Anticholinergics (e.g., Benztropine) Late Tardive dyskinesia Discontinue offending agent; consider VMAT2 inhibitors - **Neuroleptic Malignant Syndrome (NMS)**: Treat with dantrolene or bromocriptine. - **Anticholinergic Effects**: Manage with supportive care and lower doses. - **Agranulocytosis (e.g., Clozapine)**: Monitor CBC regularly. **Black Box Warnings for Clozapine and Lab Monitoring** - **Warnings**: Risk of agranulocytosis, myocarditis, seizures. - **Monitoring**: Weekly CBC during initial therapy. **Type** **Drugs** ----------------------- ---------------------------------------- Acute Mania Lithium, Valproic Acid, Antipsychotics Acute Depression Lamotrigine, Quetiapine Long-Term Maintenance Lithium, Lamotrigine, Valproic Acid **Drug** **Warning** ---------------- --------------------------------------------------- Lithium Toxicity: Requires regular monitoring of levels Carbamazepine Risk of aplastic anemia, agranulocytosis Lamotrigine Stevens-Johnson Syndrome Antipsychotics Increased mortality in older adults with dementia