Penicillin G

The gangsta of penicillins... ;-)

Name 3 cephalosporins and what is their MOA and indications?

cephalexin (Keflex)

ceftriaxone (Rocephin)

cefepime (Maxipime)

MOA is they inhibit cell wall synthesis of bacteria.

4 generations of this drug

Indications: Treat gram-positive, gram-negative, or anaerobic bacteria.

Cross sensitivity with penicillins

Treats gram +/- bacteria or anaerobic bacteria.

DONT TAKE WITH ALCOHOL. puking is not fun.

Treats meningitis

Extremely long acting.  Can cross the BBB.  Give only once a day.

Treats UTIs, skin infections, pneumonia

imipenem-cilastatin (Primaxin)

a Carbapenem drug

Inhibits bacterial wall synthesis

Reserved for complicated body cavity and connective tissue infection

Can cause seizures

Macrolides:

erythromycin (E-mycin)

Inhibits protein synthesis.

Inhibits protein synthesis

Treats: Acne, chlamydia, lyme disease, Rocky Mt. spotted fever.

Poor oral absorption.

used to treat serious gram - infections by preventing protein synthesis of bacteria.

Side Effects:

MUST KNOW this causes Nephrotoxicity (monitor BUN, creatinin, IO)

and Ototoxicity (hearing loss affects CN VIII)

and Neurotoxicity

A trough concentration at or below 1mcg/ml.  Anything above 2mcg/ml leads to ototoxicity and nephrotoxicity.

Fluoroquinolones:

ciprofloxacin (Cipro)

Destroys bacteria by altering DNA - cell dies.

Treats complicated UTIs, ANTHRAX, psudomonas, chlamydia, mycoplasma, mycobacterium.  IOW, typhoid fever, STD's, pnueumonia.  

Extensive gram - coverage.  Excreted by kidneys.

SE are Cardiac effect.  Prolonged QT interval, tendonitis or tendon rupture.

Treats: MRSA, C.Diff, UTI

Monitor serum drug levels.  Can cause redman syndrome -  (arm, neck, and face turns red).

Hold vancomycin if creatinin levels are too high.

an antiviral

impairs viral replication.

 Indications:

1. Herpes virus (1&2)

2. Varicella zoster virus (chkn pox)

3. Cytomegalovirus

4. Hep A, B, C

Antiretrovirals

zidovudine (Retrovir, AZT*,ZDV)

There are 3 distinct classes of antiretroviral agents: reverse transcriptase inhibitors, protease inhibitors, and the fusion inhibitors.

 Impairs viral replication

Used for 2 reasons:

1. Active HIV infections

2. Prophylactic therapy for known or potential exposure to HIV

Can cause bone marrow suppression!

Antitubercular:

isoniazid (INH)

Most anti-tuberculars are excreted by the liver.  These can cause LIVER TOXICITY.  Important is compliance and how long you have to take this.  Up to 2 years sometimes.

Treats TB. 

Side effects: can cause pyridoxine deficiency and liver toxicity.

Antifungal:

amphotericin B (amphocin)

fluconazole (Diflucan)

amphotericin B (amphocin) is used for life threatening fungal infections.

Can cause arrythmia and nephrotoxicity.  Pre-treat with antiemetics, antipyretics to prevent s/e.

 fluconazole (Diflucan) is used for oral and vaginal yeast infections.  Also streptococcal meningitis.

Anterior pituitary drugs:

somatropin (Genotropin)

Stimulates skeletal growth such as those with hypopituitary dwarfism. 

Causes headache, hyperglycemia, ketosis.  Doesn't work on adults.  Only while growth plates are still growing.

posterior pituitary drugs:

vasopressin (Pitressin)

Treats diabetes insipidus.

It's a vasoconstrictor that mimics ADH.

Prevents polydipsia, polyuria, and dehydration.

SE: increase BP, drowsiness, n/v, cramping, decrease urine output.

DO NOT STOP ABRUPTLY. 

Avoid use of TCAs, heparin and alcohol.

thyroxine (T4)

triiodothyronine (T3)

calcitonin

Thyroid agents:

levothyroxine (Synthroid)

replaces what thryoid can not produce itself.

Treats hypothyroidism

SE: cardiac dysrhythmia, arrest, palpitations, tachycardia, exopthalamus.

Additive effects with anticoagluants.  May decrease serum digitalis levels - thus lowering cardiac stimulant

This decreases thyroid hormone levels.

Treats hyperthyroidism with symptoms improving 2 weeks later.

SE: liver probs, bone marrow toxicity.  Also, jaundice, drowsiness, headache, vertigo, fever.

Interactions:  additive agranulocytosis when taken with other bone marrow depressants.  With oral anticoagulants, additive effects increase activity of this.  

MUST TAKE same time, dose, brand every day.

decreases blood glucose, metabolize carbs, fats and proteins, store glucose in liver and convert glycogen to fat.

SE can be hypoglycemia, cold and clammy, shock, and death.

Interactions with corticosteroids and alcohol. 

lispro (Humalog)

Onset, peak, duration

Rapid onset 5-15 min

Peak 1-2 hrs

Duration 4-6 hrs

regular insulin (Humalin R)

Onset, peak, duration 

Short Onset 30-60 min

Peak 2-4 hrs

Duration 6-10 hrs

Only insulin that can be given IV

NPH (cloudy)

Onset, peak, duration 

Intermediate onset 1-2 hrs

Peak 4-8 hrs

Duration 10-18 hrs

always mix clear to cloudy

glargine (Lantus)

Onset, peak, duration 

Long onset: 2-4 hrs

Peak: 8-14 hrs

Duration: 18-24 hrs

Oral antidiabetic agents

Name the 5

glipizide (Glucotrol): a sulfonylurea

repaglinide (Prandin): a meglitinide

metaformin (Glucophage): a biguanide

rosiglitazon (Avandia): a thiazolidinedione

acarbose (Precose): a Alpha-glucosidate inhibitor

good tongue twister..

Causes a decreased insulin resistance

Which is the preferred during pregnancy?

Insulin or oral antidiabetics?

coricosteroids affect __fluid & electrolyte_  balance (aldosterone promotes Na+ resorption in the distal renal tubule back into the blood, which pulls water & fluid along with it.  Aldosterone causes fluid & water retention) and they also _inhibit___ inflammatory and immune responses (think cortisol reduces inflammation!)

Treats Inflammation, COPD, dermatological disorders.

SE: can affect every body system

Nonsedating, doesn't cross BBB.  Good for old people (no falls).

Antihistamine to treat nasal allergies, allergic rhinities and the common cold.

intermediate antihistamine effect.  Both peripherally and centrally acting.  HIGH sedative and anticholinergic effects (drying, can't see, pee, poo)

Treats allergic rxns, motion sickness, nausea.  Can be used as a hypnotic

Drowsiness

non-opiod.  No addiction, analgesic properties (drying effect), or CNS depression.  Can cause drowsiness, dizziness, nausea. 

MOA: Directly acts on brains cough center

Good for post-surgery non-productive cough

Relievs productive cough by loosening sputum, indirectly diminishing tendancy to cough.

2 MOAs: 

1. Reflex stimulation occurs in response to irritation of GI tract.

2.  Direct stimulation of the secretory glands in the respiratory tract.

Relaxes smooth muscle in bronchioles and used for asthma. 

A selective beta 2 receptor agonist.

AE: increased HR, palpitations from increased contractility.

 Give this before flovent.

Blocks Ach receptors that cause bronchocontriction.  Dec. GI/GU activity and increases HR.

AE = dry mouth, throat, nasal congestion, heart palps, GI distress, headaches, coughing, anxiety.

Wait 5-10 min before inhaling 2nd dose.

xanthine derivative:  theophylline (Slo-bid or Theo-dur)

Causes bronchodilation by increaseing cAMP which is vital to maintaining an open airway. 

Treats ashma, chronic bronchitis and ephysema.

Asess cardiac and CNS.  

DONT take St. Johns Wort and smoke.  Your metabolism will increase and you'll need a higher dose of ? to get therapeutic effect

Give to pts 2 and older.  Binds to leukotrine receptors and prevents bronchial smooth muscle contraction, decreases mucus and edema.

Treats asthma and allergic rhinitis.  Improvement seen in 1 wk.  Watch out for Churg-Strauss syndrome

administered by oral inhalation; reduces inflammation and enhances beta-agonist activity.  Non-systemic.

Can cause pharyngeal irritaiton, coughing, dry mouth, oral fungus.  

Rinse mouth to prevent thrush

1.  Reduce inflammation

2.  enhances activity of beta-agonists

Assess cardiac and neruological.  Also assess GI.

Xanthines cause urinary retention.

Aluminum based.

Magnesium based.

Calcium based.

Antacids: aluminum hydroxide (Amphojel)

Neutralize gastric acidity by raising the pH of the stomach.

 Indications:  peptic ulcer, gastritis, gastric hyperacidity and heart burn.

Pts w/decreased renal fxn shouldn't take b/c your increasing magnesium and calcium which you won't be able to excrete causing a f/e imbalance.

SE: alum and calcium based antacids cause constipation where magnesium ones cause diarrhea.

Don't take any other meds w/in 1-2 hrs after taking antacid.

1.  Adsorption of other drugs to antacids, which reduces the ability of the other drugs to be absorbed in the body.

2.  Chemical inactivation of other drugs by chelation which produces insoluble complexes.

3.  INcreased stomach pH

4. Increased urinary pH which increases excretion of acidic drugs and decreases the excretion of basic drugs.

Blocks 90% of acid secretions made by parietal cells.

Treats GERD, heartburn, ulcers, indigestion.

This inhibits the absorption of drugs requiring an acidic environment.

Be alert for mental changes. 

PPIs block ALL acid secretions.

Treats: GERD, gastric ulcers, h.pylori

Safe

prostaglandin-like

Reduces incidence of gastric ulcers in people taking NSAIDS

Decreases bowel motility

Treats Diarrhea

SE: opiates cause drowsiness, sedation, bradycardia, resp distress

Additive CNS depressant effect with other CNS depressants

Decreases bowel motility

Treats Diarrhea

SE: opiates cause drowsiness, sedation, bradycardia, resp distress

Laxatives.

Name the 5 categories

1. bulk forming

2. emollient

3. hyperosmotic

4. saline

5. stimulant

emollient stool softener

Treats constipation or fecal impaction.  Good for people w/hemorroids

Can cause decreased K levels and f/e imbalances.

bulk forming laxative

Safest to take b/c its additive fiber and action is limited to the GI tract.

ONLY laxative that can be used long term.

Can cause F/E imbalance and gas.

hyperosmotic saline laxative

ALSO an antacid b/c its magnesium based, it can cause diarrhea.

Can cause f/e imbalances and decreased K.

an antihistamine

used for motion sickness

prochlorperazine (Compazine)

a Neuroleptic drug

treats psychotic disorders like mania and schizo, and their associated anxiety; intractable hiccups, n/v.

SE: EPS

a Serotonin blocker

a major breakthrough to treat chemotherapy induced n/v and later post-op nausea.

Administer before chemo

THC marijuana derivitive

Used for chemo n/v and stimulate appetite for weight gain in HIV/AIDS and chemo pts.

You may find yourself hungry for White Castle or Taco Bell.

reglan

a prokinetic

Used for delayed gastric emptying.  Take before meals to stimulate GI tract.