Glucocorticoids

estrogen

furosemide

thiazides

beta-blockers

nicotinic acid

HgbA_1c ≤ 6.9%

controlled hypertension and lipids

micoralbumin < 30µg/ml

Examples of Sulfonylureas

Method of Action

glyburide, glipizide

stumulate insulin secretion by pancreatic beta cells and increase the sensitivity of tissues to actions of insulin

hypoglycemia

also, weight gain can be an issue

sulfa allergy

also, be careful with the elderly

Example of Biguanides

method of action

Metformin

Increases sensitivity of tissues to insulin

reduces intestinal uptake and hepatic production of glucose

D/N/V, abdominal bloating, flatulance, anorexia, dysgusia

rarely - lactic acidosis (potentially fatal), risk increases with age and worsening renal fxn

example of thiazolidinediones (TZDs)

method of action

avandia, actos

enhances response to target cells (liver, muscle) to endogenous insulin

LFTs

discontinue if LFTs are > 3x normal

(you should check LFT's before starting any diabetic med)

ovulation may resume and unintended pregnancy is a possibility

also stimulates weight gain

may exacerbate CHF

myocardial ischemia

examples of Alpha-Glucosidase Inhibitors

method of action

Precose, Glyset

slow carbohydrate digestion resulting in lower serum glucose levels after meals

examples of Meglitinide Analogs

method of action

Prandin and Starlix

blocks potassium channels in pancreatic beta cells → stimulates insulin secretion

what is the most common insulin regimen

when should it given

mixture of an intermediate acting insulin and rapid or short acting insulin twice daily:

15 minutes before breakfast and 15 minutes before dinner.

Meds for Hypothyroidism

what needs to be monitored?

T₄ replacement (synthroid and others)

therapy is lifelong and TSH needs to be monitored

beta-blockers - symptom control

iodine compounds - severe thyrotoxicosis/thyroid storm

glucocorticoids - thyroid storm

Bactrim

Macrobid (Nitrofurantoin)

prego with pyelonephritis

glomerulonephritis

severe hepatitis

UTI OTC

for pain, burning, stinging

SE

AZO

will stain things (contact lenses, clothes, urine "grossly bloody")

UTI in pregos

do you need a CBC, why?

yes

to see how systemic the infxn is

meds for UTI in pregos

Rocephin IV

Macrobid PO

Pyelonephritis

presentation

Labs

writhing in pain, toxic looking

U/A, culture, CBC

Renal Calculi

acute meds

pain meds

hydration

nausea meds

PPI or H2 blocker (vasodilate)

STD

what you should know

treat partners

it is better to treat and street than to re-call patients

Zithromax

Doxy

alt - fluoroquinolones

rocephin

alt - cipro, suprax

what can vaginitis be an indicator of?

meds for bacterial vaginosis

what about pregos

Flagyl or

clindamycin vaginally

Flagyl (except in 1st trimester)

meds for vaginal candidiasis

diflucan

Terazol

OTC - monostat, gyne-lotrimin

can flagyl be used in pregos

bactrim

cipro, levaquin

doxycycline

BPH meds

main point to tell patients

main SE

flomax, avodart

it may take months to get better

main SE:  orthostatic hypotension

Meds for ED

what do you do before you write a Rx

Cialis, Viagra, Levitra

labs, cardiac workup, NO NITRATES!

Ditropan

Detrol

Psuedophed

estrogen

TCAs

bowel obstruction, colitis, glaucoma, myasthenia gravis

caution with hepatic and renal impairment

acyclovir

famciclovir

valacyclovir

best delivery method for treating contact derm

good for the scalp

ointment and gels

solutions-alcohol-based liquids

topical corticosteroids

start with intermediate or high potency then reduce to low

use low potency on face

topical corticosteroid education

SE

don't use longer than 2 weeks in adults and 1 week in kids

occlulsive dressing enhances the effect

chronic use is discouraged

SE:  skin atrophy, ecchymosis, cataract formation, acne-like lesions

Systemic Coritcosteroid use

what you should know

if widespread or resistant to topical tx

use a tapering dose

take early in the day to avoid sleep disturbance

Systemic Coritcosteroid

CI

SE

CI:  immunocompromised, systemic fungal infxn

SE:  elevated glucose, and BP

mood changes

topical immunosuppressives (if topical cortiocosteroids are ineffective/CI)

antihistamines for itching

griseofulvin

gris-peg

topical azoles

directions

CI

cautions

use in t. corporus, cruris, pedis, manus, & cutaneous candidiasis

apply 1-2 x daily, thin coat beyond border of rash for 2-6 weeks

(always treat for 1 week after the rash has disappeared)

CI:  pregos or lactating

caution in pts with liver failure

Griseofulvin

SE

1st line for t. capitus

N/V/D

increases warfarin levels

Allylamine

SE

labs

onychomycosis

diarrhea, rash, can cause liver failure

LFTs must be checked prior to Rx then 4-8 wks into Tx

systemic azoles

cautions

t. capitis & onychomycosis

careful with hypoglycemic agents and warfarin

don't mix with drugs metabolized by CYP3A (quinidine)

1st line - selenium shampoo and topical azoles

2nd line - systemic azoles

candidiasis tx

if pt has recurrent candidiasis problems what must you rule out

keep area dry if possible

burow's solution

medicated powder

topical azoles

Nystatin for thrush

you must rule out HIV & DM

DNA viral infxns

Tx

Herpes, papilloma, pox viruses

ensure primary prevention for common viral diseases for which there is a FDA approved vaccine

Viral drug therapy

goal

topical

systemic

goal is to reduce the duration of symptoms and

SUPPRESS THE PAIN

topical:  acyclovir and penciclovir (Denavir)

initial treatment at the 1st sign of infection

systemic:  acyclovir (Zovirax)  famciclovir (Famvir) and valacyclovir (Valtrex)

tx must be started early in the disease process or it's of little value

verrucae

goal

meds

vulgaris - common HPV-2

plantar HPV-1

non-anogenital usually resolve spontaneously

goal is eradication of the lesion

1st line - salicylic acid (liquid, gel, patches)

2nd line - cryosurgery, electrosurgery, laser

Impetigo

tx: 1st & 2nd line

common in kids, honey crusted, very contagious

1st line - topical mupirocin (Bactroban)

2nd line - oral abx, usually broad spectrum PCN (Augmentin, dicloxacillin) or

Cephalosporin (cephalexin) or

erythromycin if PCN allergy

superficial strep infxn that spreads to the deeper dermis, subQ, fat and dermal lymphatics

oral abx are necessary and must be initiated early;

use broad spectrum PCN, Ceph, or macrolide while waiting for the C&S

caused by Staph

warm compresses,

Bactroban, Bacitracin

oral broad spectrum PCN

if suspect pseudomonas use a quinolone

must be suspected if cellulitis doesn't respond to tx

1st line - surgical intervention with empiric broad spectrum abx

Psoriasis Tx

meds

Emollients to hydrate (eucerin, lubriderm)

topical corticosteroids for short term

topical immunosuppressives (tacrolimus, pimecrolimus)

Retinoid gel or systemic (lots of SE)

Methotrexate - inhibits cellular replication

Enbrel - subQ

Vitamin D (Dovonex)

Coal tars - poor compliance due to odor, stains, photosensitivity

Acne

what is the most important treatment?

meds

skin care is the most important treatment

Retinoic acid (Retin A)

Adapalene get (Differin)

Benzoyl peroxide - irritation problems

Azelaic acid

topical abx (Clindamycin 2% or Erythromycin 2 or 3%)

Oral abx for inflammatory acne (Tetracycline)

Isotretinoin (Accutane) - reserved for pts with severe nodulo-cystic acne (black box waring of severe birth defects)

topical metronidazole (MetroGel)

Oral abx - tetracycline

also doxy, erythro, accutane

lindane or permethrin (elimite) cream

pts and family members must be treated at same time

lindane or permethrin CI

instructions

neurotoxin = avoid in infants, pregos or lactating women and pts with a seizure disorder

pts and family members must be treated at same time

apply from neck down overnight

topical permethrin (OTC) or lindane

Shampoo formula is best for hairy areas

Brown recluse tx

mild

severe

mild:  rest, ice, pain control, abx for 2nd infxns, antihistamines for itching

severe:  dapsone, oral prednisone, surgical debridement may be necessary

sunburns best tx

tx

best tx is PREVENTION

cool compress, OTC analgesic, silvadene or bacitracin cream for blistered skin

skin cancers

suspicious lesions

tx

send all suspicious lesions for biopsy

aldara cream is being used for early cancer

self limiting

antihistamines may help the itching

blood, PRBCs

fluids

Iron

search for the source

blood only if acute change, or level is very very low

Iron

Name some iron supplements

2 Precautions

SE

Feosol

Fergon

Fero-folic acid

slow Fe

1) before prescribing, check whick ones are for children

2)  most Fe compounds inhibit tetracycline

SE:  black stool, constipation/diarrhea, nausea

prednisone/corticosteroids

platelets

splenectomy

if drug is causing it stop the drug

Corticosteroids

Medrol examples

(medrol dose pk, Depo-Medrol, Solu-Medrol)

tabs, susp, IM, IV

Corticosteroids

Prednisone available doses

general rule for dose

1,2.5,5,10,20,50 mg tabs

in general 1-2 mg/kg/day adults and kids

Corticosteroids

Decadron available forms

(Dexamethasone)

tabs, susp, IV, IM

Corticosteroids

Prednisolone examples and dose

(Orapred) (Prelone)

15 mg/5mL for Peds

weight in kg never lbs

kidneys and liver cannot tolerate adult doses

more vulnerable to respiratory suppression

the less # of times a day a drug has to be given the better compliance

assume any allergic rxn with any distress will progress to anaphylaxis and act w/out hesitation

Geriatric Pharm

when are pain meds CI

CI:  decreased renal fxn or

respiratory depression

Geriatric Pharm

what to watch out for

Psych Pharm

what needs to be done before a Rx is given