PRNU 128: Exam 2

Nonselective Adrenergic Bronchodilator: Epinephrine (Adrenalin)

Acute attack of bronchoconstriction with stridor - MoA: Stimulates alpha, beta1 (cardiac), and beta2 (respiratory) receptors to increase rate/force of contraction - Contraindications/AE: Cardiac issues (positive inotrope, chronotrope, and dromotrope) - Injected SubQ, therapeutic in 5 min, and lasts 4 hours

Antirheumatoid Arthritis Drugs: Methotrexate & Etanercept/Enbrel

- Methotrexate: Cytotoxic immunosuppresive agent (rheumatrex) - Etanercept (Enbrel): Treats rheumatoid arthritis (juvenile RA) and psoriasis > Inhibit TNF, suppresses immune function and antineoplastic > Pt screened for latex allergy > Onset is 1-2 weeks and contraindications include active infections (reactivation of hepatitis and TB reported)

Amantadine/Symmetrel (Influenza A)

- MoA: Adamantanes: Blocks uncoating of virus, preventing penetration in host - AE/Contraindications: Hypersensitivity, anticholinergic effects, CNS depression, orthostatic hypoTN, and bluish mottling

Benzonatate/Tessalon Pearls (Antitussive)

- MoA: Anesthesizing stretch receptors in respiratory passages, decreasing coughing (peripherally acting) - AE: Choking feeling, chest pain, numbness, dizziness, confusions, and hallucinations - Pt swallows capsules whole

Corticosteroids

- MoA: Inhibit arachidonic acid metabolism, strengthen/stabilize biological membranes, inhibit production of IL-1/TNF, impair phagocytosis, impair lymphocytes, and inhibit tissue repair > Results in decreased mucus secretion, decreased airway mucosa edema, repaired epithelium, and reduced airway reactivity - Use: Allergic/hypersensitivity disorders (chronic asthma), collagen disorders (lupus), dermatologic disorders, and endocrine disorders > Do NOT relieve acute asthmatic attack symptoms - AE: Moon face (redistributed fat) and diminished immunity - Oral or inhaled (reduces systemic effects), may take several weeks for full effects, and rinse mouth with warm H2O to prevent oral fungal infections - Drugs: Prenisone (Deltasone), betamethasone, budesonide, cortisone, flunisolide, and fluticasone, ciclesonide > Dulera (Mometasone): Beta 2 agonists/corticosteroid

Macrolides

- MoA: Prevent protein synthesis within bacterial cells, bacteriostatic, and can be bactericidal in high concentrations - Indications: Strep infections (streptococcus pyogenes > group A beta-hemolytic streptococci), URI/LRI (haemophilus influenzae), spirochetal infections (syphilis and lyme), gonorrhea, chlamydia, and mycoplasma - AE: GI effects (N&V, diarrhea, hepatoxicity, farting, jaundice, anorexia) primarily with erythromycin > Azithromycin and clarithromycin have fewer GI AE, longer duration of action, better efficacy, and better tissue penetration - Drugs: Erythromycin, Azithromycin (Zithromax), and Clarithromycin (Biaxin) > Biaxin approved for use in combination with omeprazole for treatment of active ulcer disease associated with H. pylori infection

Chemotherapy Nursing Implications

- Monitor for anaphylactic reactions - Keep epinephrine, antihistamines, and anti-inflammatory drugs on hand - Monitor for bone marrow suppression complications (anemia, thrombocytopenia, and neutropenia) - Expect N&V, diarrhea, and stomatitis (alkaline agents) - IV or PO allopurinol (zyloprim) to reduce hyperuricemia (gout)

Alkylating Drugs: AE

- N&V and myelosuppression (dose limiting AE) - Alopecia, nephrotoxicity (hydration can prevent), peripheral neuropathy, ototoxicity, and extravasation cause tissue damage/necrosis

Antihelmetic Drugs: Pyrantel (Antiminth)

- NEED to identify causative worm by finding parasite ova or larvae in feces, urine, blood, sputum, or tissue - Pyrantel: Used for intestinal roundworm (nematodes) ascariasis, enterobiasis, and other infections > MoA: Blocks AcH at neuromuscular junction, resulting in paralysis of worm, which are then expelled through GI tract > Cannot be used while pregnant - Albendazole (Albenza): Inhibits uptake of glucose, leading to autolysis of worm (treats roundworms, pinworms, hookworms, and tapeworms > Potential myelosuppression

Common Cold

- Often caused by viral infection (rhinovirus or infleunza) > Invades tissues of upper respiratory tract (URI) - Treatment is symptomatic only (NOT curative nor eliminates causative pathogen) - H1 antagonists (antihistamines) include chlorpheniramine, fexofendadine (allegra), loratadine (claritin), cetirizine (zyrtec), and diphenhydramine (benadryl) - H2 antagonists used to reduce gastric acid in peptic ulcer disease > Cimetidine (Tagamet), Ranitidine (Zantac), and Famotidine (Pepcid)

Antitussives

- Opioids: Suppress cough reflex by direct action on cough center in medulla (EX: Codeine [Robitussin & Dimetane] and Hydrocodone) - Nonopioids: Suppress cough reflex by numbing stretch receptors in respiratory tract and preventing stimulation of cough reflex (EX: Tessalon Pearls and Dextromethorphan)

Proponic Acid Derivatives & Salicylates (Aspirin)

- PAD: Ibuprofen (Motrin) & Naproxen (Aleve) - Ketorolac (Toradol): Short term IV NSAID used for pain and helps migraines - NSAID + Caffeine = Excedrin - Aspirin (Acetylsalicylic Acid): Antiplatelet effect > Reye's Syndrome: Encephalopathy and fatty liver accumulation associated with use of aspirin after viral infections (chickenpox or influenza) in children

Nursing Implications for Immunosuppressants

- Perform assessment before administering drugs: renal, liver, CV function, CNS baseline, respiratory, baseline VS, hemoglobin, hematocrit, WBC, and platelet counts - Oral antifungals given with these drugs to treat oral candidiasis - Observe oral cavity for white patches on tongue, mucous membranes, and oral pharynx

Xanthine Derivatives

- Plant alkaloids such as caffeine, theobromine, and theophylline > Only theophylline is used as bronchodilator > Synthetic xanthines: aminophylline - Causes bronchodilation by relaxing smooth muscles in airways, resulting in relief of bronchospasm and greater airflow in/out of lungs (causes CNS stimulation)

Trimethoprim-Sulfamethoxazole/Bactrim (Sulfonamide)

- Uses: Broad spectrum, PJP, severe UTIs, shigella enteritis, enterobacteriaceae, outpatient staph infections, and OM in kids - MoA and contraindications same as sulfasalazine - Do NOT mix with other drugs or solutions, IV line flushes, assess allergic RXN (metabisulfite), and St. John's Wart increases effects

Sulfasalazine/Azulfidine (Sulfonamide)

- Uses: Broad spectrum, ulcer colitis, RA, UTIs, and reduces clostridium and E.coli in stools - MoA: Antimetabolites of para-aminobenzoic acid, required to produc folate (necessary for production of bacterial intracellular proteins) - Contraindications: Sulfa allergies, hepatic/renal disease, and intestinal or urinary obstruction - AE: GI (stomatitis most common), hematological, dermatological, and urinary (crystalluria) - May turn urine yellow-orange, drink 2000mL/day to prevent crystalluria, bacteriostatic action occurs in intestine, and St. John's wart enhances effects

Tobramycin (Aminoglycoside)

- Uses: Similar to gentamicin, but more active against Pseudomonas organisms, aerobic gram-, sepsis, respiratory, UTI, intraabdominal, osteomyelitis, and inhalation for CF - MoA: Bacterial cell membrane is defective and cannot synthesize proteins - AE: Nephrotoxicity (can be reversible if drug discontinued), ototoxicity, and Red Man syndrome (skin slough off emergency) - Given once daily (increase efficacy and decrease nephrotoxicity), monitor serum levels - Other Drugs: Gentamicin and Neomycin (given orally to decontaminate GI tract before surgery, used as enema, and can treat hepatic encephalopathy)

Active Immunity Agents

- Vaccines: Suspension of microbes intended to induce antibody formation for prevention of disease, producing long-lasting immunity (small risk of developing disease with live vaccines if immunocompromised) - Toxoids: Bacterial toxins modified to destroy toxicity, but retain antigenic properties (not permanent and need boosters) > Uses: Diphtheria, HiB infection, hepatitis A/B, infuenza A/B, MMR, pertussis, poliomyelitis, rotavirus, tetanus, varicella, and pneumococcal infection > Adolescents/Adults: Diptheria, tetanus, pertussis, rubella (girls), high risk populations, and annual influenza > Contraindications: Febrile illnesses, immunosuppressive drug therapy, leukemia, lymphoma, generalized malignancy, and pregnancy

Niacin (Nicotonic Acid)

- Vitamin B3 - Lipid-lowering properties requiring higher doses than when used as vitamin - Effective, inexpensive, and often used in combination with other lipid-lowering drugs - SE: flushing, itching, and GI (if itching occurs, lower dose is needed)

Folic Acid

- Water soluble, B-complex vitamin, and essential for erythropoiesis - Indications: Folic acid deficiency and during pregnancy to prevent neural tube defects (untreated pernicious anemia results in neurological damage) - Malabsorption syndromes are the most common cause of deficiency (ileostomies)

Fungi

- Yeasts: Single-cell fungi, budding reproduction, and can be used for baking or alcohol - Molds: Multicellular fungi characterized by long, branching filaments (hyphae)

Mycotic Infections

- 4 Types: Cutaneous, SubQ, superficial, and systemic (life threatening and usually occurs in immunocompromised host) - Candida Albcans: Caused by antibiotic therapy, antineoplastics, or immunosuppresants (corticosteroids) that may result in overgrowth and systemic infections > Common in newborn infants and immunocompromised pts > Growth in mouth is called thrush - Vaginal Candidiasis (Yeast Infection): Pregnancy, women with diabetes, women taking oral contraceptives, and antibiotic therapy

Fibrates (Fibric Acid Derivatives)

- Activate lipase (breaks down cholesterol), suppresses release of free fatty acid from adipose tissue, inhibits triglyceride synthesis in liver, and increases cholesterol secretion in bile - Caution with liver - Drugs: Gemfibrozil (Lopid) and Fenofibrate (Tricor)

Coagulation Drugs

- Anticoagulants: Inhibit action or formation of clotting factors OR prevent clot formation (no influence on current clots) > Used prophylactically for MI, unstable angina, atrial fib, indwelling devices (mechanical heart valves), and orthopedic surgeries > Contraindications/AE: Bleeding (risk increases with dosages and can be localized or systemic), N&V, abdominal cramps, and thrombocytopenia - Antiplatelet Drugs: Inhibit platelet aggregation and prevent platelet plugs - Coagulation Modifier Drugs: Hemorheologic drugs (alter platelet function), thrombolytic drugs (lyse existing clots), and antifibrinolytic or hemostatic drugs (promote blood coagulation)

Montelukast/Singulair (LTRA Prototype)

- Long term effective in patients with asthma who do not respond to other therapies (can be used with glucocorticoid and adrenergics) - MoA: Prevent leukotriene release - AE: Low toxicity, nausea, headache, diarrhea, and infection - Take at bedtime and can be exercise induced (only oral tablet approved for exercise induced asthma)

Atorvastatin/Lipitor (HMG-CoA Reductase Inhibitor Statins Prototype)

- Antilipemic drug used to lower lipid levels (adjunct to diet therapy) - Indications: Most potent LDL reducer, hypercholesterolemia, and reduces CV events in patients with risk factors - MoA: Inhibit HMG-CoA reductase used for hepatic synthesis of cholesterol (reduces LDL cholesterol and triglycerides while increasing HDL) > Statin decreases cholesterol production - Contraindications: Pregnancy (X), lactation, and hypersensitivity - AE: Hepatic dysfunction, headache, rash, GI problems, myopathy (injure muscle tissue, resulting in muscle weakness - rhabadomyolysis), and increased liver enzymes - Use caution with erythromycin, azole antifungals, verapamil, diltiazem, HIV protease, amiodarone, grapefruit juice, and statin myopathy - Other Drugs: Simvastatin (Zocor), Pravastatin (Pravachol), and Rosuvastatin (Crestor)

Antiprotozal Drugs

- Atovaquone (Mepron): Selective inhibition of mitochondrial electron transport of protozoa (result is no energy, leading to cell death) > Treats mild/moderate Pneumocystis jiroveci and AE includes N&V, diarrhea, anorexia, increased liver enzymes, etc - Metronidazole (Flagyl): Disruption of DNA/nucleic acid synthesis and treats trichomoniasis, amebiasis, giardiasis, pseudomembraneous colitis, and C. diff (possesses antihelmetic activity) > AE: Metallic taste, N&V, diarrhea, and abdominal cramps - Pentamidine (Pentam-300): Inhbits DNA/RNA, binds/aggregates ribsomes, and mainly treats PJP

Second Generation Cephalosporins

- Cefaclor (Ceclor): More active against H. influenzae and E.coli than first generation (used more in children) - Cefotetan (Cefotan): Effective against most organisms (except Pseudomonas) and highly resistant to beta-lactamase enzymes (used for severe infections) - Cefuroxime (Kefurox/Zinacef): Similar to other second-generation cephalosporins - penetrates CSF in presence of inflamed meninges (sinus and upper resp. infections) > Zinacef is parenteral form whereas Ceftin is PO, surgical prophylaxis, and does not kill anaerobes - Cefoxitin (Mefoxin): First cephamycin used prophylactically for abdominal or colorectal surgeries (kills anaerobes)

Third Generation Cephalosporins

- Ceftriaxone (Rocephin): Once-a-day dosing used against most gram-positive and gram-negative bacteria, including several resistant strains > IV or IM, elimination is hepatic, and easily passes meninges/diffused into CSF to treat CNS infections - Ceftazidime (Fortaz): Active against gram-positive and gram-negative (Pseudomonas aeruginosa + other resistant strains to aminoglycosides) organisms > IV or IM, used for serious infections, excellent gram negative coverage, excellent spectrum coverage, and resistance limits usefulness - Cefotaxime (Claforan): Active against gram-positive and gram-negative organisms, including strains resistant to other antibiotics

Miscellaneous Antibiotics

- Clindamycin (Cleocin): Used for chronic bone infections, GU infections, intra-abdominal infections, and other serious infections > May cause pseudomembranous colitis (C. difficile infection) - Linezolid (Zyvox): Oxazolidinones: Used to treat VREF & VRE and skin structure infections (MRSA) > May cause hypoTN, serotonin syndrome with use of SSRIs, and reactions if taken with tyramine - Nitrofurantoin (Macrodantin): Used for UTIs, use carefully with impaired renal function, concentrates in urine, and may cause fatal hepatotoxicity - Quinupristin (Synercid): 30:70 combination, synergistic, used for VRE and skin structure infections (S. pyogenes and S. aureus including MRSA), and may cause arthralgias or myalgias - Daptomycin (Cubicin): Lipopeptides: Binds to gram+ cells in calcium dependent process to disrupt cell membrane potential and treats skin/soft tissue infections (MRSA/VRE)

Direct Thrombin Inhibitors (DTI)

- Dabigatran (Pradaxa): No reversal, lifestyle inhibitor used 2x a day, and easier to maintain INR - Apixaban (Eliquis): Inhibits clotting factor Xa - Argatroban: Do NOT use with liver dysfunction (thrombocytopenia)

Nonsedating/Peripheral Acting Antihistamines

- Developed to eliminate unwanted AE (mainly sedation) - Work peripherally to block histamine actions (fewer CNS AE) - Longer duration of action increases compliance > EX: Fexofenadine (Allegra), Loratadine (Claritin), Cetrizine (Zyrtec) > Traditional antihistamines work peripherally/centrally and have anticholinergic effects, making them more effective than nonsedating drugs > EX: Diphenhydramine, Chlorpheniramine, Meclizine, Proomethazine

HIV & AIDS

- ELISA: Detects HIV exposure based on presence of human antibodies to virus in blood - Stages (WHO Model): Asymptomatic infection, early/general SX of disease, moderate SX, and severe SX (often death) - Antiretroviral Drugs: HAART: At least 3 medications used to reduce viral load > EX: Nevirapine (Viramune), Tenofovir (Viread), and Zidovudine (Retrovir) > RTIs: Block activity of enzyme reverse transcriptase, preventing production of new viral DNA > PIs: Inhibit protease enzyme, preventing viral replication > Fusion Inhibitors: Inhibit viral fusion > Early Inhibitor CCR5 antagonists and HIV integrase strand transfer inhibitors

Antibiotic Therapy

- Empiric Therapy: Treatment of infection before specific culture information has been reported - Definitive Therapy: Antibiotic therapy tailored to treat organism identified within cultures - Prophylactic Therapy: Treatment with antibiotics to prevent infection (EX: intraabdominal surgery or after trauma) > ESSENTIAL to obtain cultures from appropriate sites BEFORE beginning therapy

Acetaminophen (Nonnarcotic Analgesic Antipyretic)

- Equal to aspirin in analgesic and antipyretic effects, but lacks anti-inflammatory activity - Metabolized in liver (overdose results in liver damage or fetal liver necorsis) - Overdose cause hepatotoxicity, liver function tests show increased levels after 24-48 hours, and later CMs include jaundice, vomiting, CNS stimulation, delirium, coma, and death > Maximum daily dose of 4 grams/day - Toxicity treatment includes gastric lavage and activated charcoal after 4hr of ingestion OR acetylcysteine (mucomyst) > Oral/IV, most beneficial if given 8-10hr after ingestion, and does NOT reverse damage already sustained

Cefadroxil/Duricef & Cephradine/Volsef (First Generation Cephalosporins)

- Long acting against gram+ and note administered as often - Same MoA, contraindications, and AE as other first generations - Duricef is IV antibiotic

Cephalexin/Keflex (First Generation Cephalosporin)

- Long acting against gram+, not administered often, and used in post-op TX, UTIs, and pneumonia - Same MoA, contraindications, and AE as other first generation cephalosporins - Given PO and send them home on Keflex post-op for 5-7 days

Iron

- Essential mineral, oxygen carrier in hemoglobin, stored in liver, spleen, and bone marrow, and deficiency results in anemia - Some foods enhance (OJ, veal, fish, ascrobic acid) OR impair (eggs and corn) iron absorption - Oral iron preparations available as salts (ferrous fumarate, gluconate, and sulfate) OR parenteral (iron dextran, ferric gluconate, and iron sucrose/venofer) > Iron Dextran: May cause anaphylactic reactions, test done given first (remainder given after 1hr), and used less frequently > Ferric Gluconate & Iron Sucrose: Used for patients with chronic renal disease and iron deficiency anemia, less risk of anaphylaxis, and hypotension is most common AE (related to infusion rate) - AE: Common cause of pediatric deaths, N&V, diarrhea, constipation, black tarry stools, stomach cramps, pain, liquid oral prep may stain teeth, and injectable forms may stain skin

Antimetabolities

- Folate Antagonists: Methotrexate (Trexall): DNA not produce and cell dies - Purine Antagonists: Interrupts DNA and RNA synthesis > Fludarabine (F-AMP), Mercaptopurine (6-MP), and Thioguanine (6-TG) - Pyrimidine Antagonists Interrupts DNA and RNA synthesis > Fluorouracil (5-FU) and Cytarabine (ARA-C)

Herbal Products: Garlic & Omega 3

- Garlic used as an antispasmodic, antihypertensive, antiplatelet, and lipid reducer > AE: Dermatitis, vomiting, diarrhea, flatulence, and antiplatelet activity > May enhance bleeding when taken with NSAIDs and anticoagulants - Omega 3 fatty acids are fish oil products used to reduce cholesterol > May cause rash, belching, and allergic reactions (potential interactions with anticoagulant drugs)

Cefazolin/Ancef (First Generation Cephalosporin Prototype)

- Gram+ coverage and choice drug for surgical prophylaxis - MoA: Inhibits third/last step of bacterial wall synthesis by binding to one or more penicillin-binding proteins - Contraindications: Severe anaphylactic reaction to penicillin - AE: Hypersensitivity RXN, superinfection, abdominal pain, diarrhea, gastritis, and N&V - Administer within 30 minutes before OR to reduce rate of infection, given IV or IM, vitamin K depletion, and monitor pt on anticoagulants

Fluticasone/Flovent (Glucocorticoid Intranasal Steroid)

- Indications: Acute asthma unreleived by inhaled b-adrenergic bronchodilators, in conjuction w/ other drugs for prophylaxis, and allergic rhinitis (nasal spray) - MoA: Increase # and effectiveness of b-adrenergic receptors and suppress inflammatory mediators, cytokines, and eosinophils - Contraindications: Allergy or recent nasal injury, surgery, and ulcers - AE: Suppress HPA axis and adrenocortical function (topical admin minimizes this), candidasis, dry mouth, hoarse, and dry mucosa - Rinse mouth after inhaled use, use spacer, decrease amount deposited in oral cavity

Daunorubicin/Cerubidine (Antitumor and Anthracycline Agent)

- Indications: Acute leukemias and lymphomas (causes immune suppression) - MoA: Bind to DNA, so DNA/RNA transcription is blocked (active in all phases of cell cycle) - Contraindications: Pregnancy, lactation, WBCC < 2000 cells/mm3, neutrophil count < 1500 cells/mm3, and platelet count < 50000/mm3 - AE: Heart failure (destroys cardiac muscles/CARDIOTOXIC), BMS (burning mouth), bone marrow depression, alopecia, mucositis, GI upset, hepatotoxicity, and cardiomyopathy - Individualize dosing (dosage reduction according to serum bilirubin, hepatotoxic, liver function testing) and may turn urine reddish color (normal)

Metronidazole/Flagyl (Ambecide Prototype)

- Indications: Anaerobic bacteria (gram- bacilli C. difficile), intra-abdominal infections, gynecologic infections, and protozoa infections - Contraindications: First trimester of pregnancy with caution in pts with CNS or blood disorders - AE: Dermatological, CNS, GI, metallic taste, and disulfiram RXN (flushing, headache, N&V, chest/ab pain)

Doxycycline/Vibramycin (Tetracycline)

- Indications: Anthrax post-exposure, chlamydia, mycoplasma pneumo, traveler's diarrhea (E.coli), gonorrhea, and acne - MoA: Binds to ribosomes, inhibits microbial protein synthesis, and suppresses growth of acnes - Contraindications: Young age (<8 years), pregnancy, and renal failure - AE: Permanent discoloration of teeth, defects in tooth enamel, and bone growth retardation - Minimum infusion period is 1hr in IV, mix with LR or dextrose, administered in small doses/less frequently d/t long serum half-life of 18hr, and anticoagulants with tetracycline enhances vitamin K - Other Drugs: Demeclocycline (Declomycin): Used to treat SIADH by inhibiting action of ADH

Vancomycin

- Indications: Gram+ infections, MRSA, endocarditis, E.faecalis, prophylaxis, IV cathethers, invasive TX, and oral vanco for enterocolitis (C.diff)/pseudom - MoA: Inhibits cell wall synthesis - AE: Red Man syndrome (hypoTN, flushing, skin rash d/t histamine), hepatoxicity, and ototoxicity - Should be infused over 60 minutes (rapid infusion cause hypoTN, draw trough 30min before admin (10-20 <15 best), and peak after (25-50)

Anticholinergics: Tiotropium (Spiriva)

- Long acting, 24 hour bronchodilator taken once daily by inhalation for maintenance therapy of bronchoconstriction associated with COPD - MoA: Same as ipratropim - Contraindications: Acute bronchospasm - AE: Dry mouth (primary), headache, dizziness, ab pain, constipation, diarrhea, flu-like SX, and chest pain - Repeat inhalations 2-3 times to ensure drug is inhaled (rattle is audible) - More superior than ipratropium

Interferon Alfa-2b/Intron-A (INF Prototype)

- Indications: Hairy cell leukemia, chronic hepatitis B/C, AIDS kaposi's sarcoma, malignant melanoma, and condylomata - MoA: Antiviral (inhibit replication) and antineoplastic activities, increase phagocyte activity, and inhibits replication of cancer cells - Contraindications: SX of liver disease, autoimmune hepatitis, or posttransplantation immunosuppression - AE: Flu-like SX within 2hr of administration (fever, chills, headache, myalgia), fatigue (dose limiting), chest pain, alopecia, dizziness, N&V, diarrhea, and psychiatric complications - Teach patients to report sign of infection immediately (sore throat, diarrhea, vomiting, fever >100) and do not give suppositories

Warfarin/Coumadin (Vitamin K Antagonist Prototype)

- Indications: LT management of venous thromboembolic disorders, DVT, PE, embolization associated w/ A-fib, and prosthetic heart valves. Post MI/Stroke - MoA: Acts in liver to prevent synthesis of vitamin K dependent clotting factors as competitive antagonist - Contraindications: GI ulcers, bleeding, severe kidney/liver disease, severe HTN, recent surgery of eye, spinal cord, or brain, pregnancy (X), and caution with mild HTN and renal/hepatic disease - AE: Hemorrhage, N&V, abdominal pain, alopecia, urticaria, dizziness, and joint/muscle pain - Monitor PT/INR (INR is 2-3 on drug), drawn until therapeutic, and only given orally in morning after blood drawn - Antidote: Vitamin K, FFP (IV/IM with slow action)

Altepase/Activase (Thrombolytic rTPA Prototype)

- Indications: Management of acute or severe thomboembolic disease (MI, PE, IT) - CLOT BUSTING - MoA: Stimulate plasminogen to plasmin and breaks down fibrin (framework of thrombus) - Contraindications: Severe HTN, aneurysm, AVMs, coagulopathy or internal bleeding, invasive surgery or trauma, and oral anticoagulants or antiplatelets - AE: Hemorrhage with increase risk of emboli in patients with A-fib, bleeding (internal/intracranial), hypoTN, anaphylaxis, and cardiac dysrhythmias - INR, aPPT, platelet count, and fibrinogen needed pre-administration to determine if blood coagulation disorder is present and used via IV or bolus - Antidote: Aminocaproic Acid (Amicar) - Other Drugs: Tenecteplase (TNKase)

Adalimumab/Humira (TNF Alpha Blocking Agents)

- Indications: Moderate to severe RA (reduces elevated TNF-alpha levels in synovial fluid) - MoA: Recombinant monoclonal antibody, bind to TNF-alpha receptor sites, and prevents endogenous TNF-alpha from exerting effects - AE: Injection site RX, upper resp. tract infections, headache, nausea, and skin rash

Hematopoietic Drugs

- Indications: Patients experiencing destruction of bone marrow cells due to cytotoxic chemotherapy and renal patients > Decrease duration of low neutrophil conts (reducing incidence/duration of infection), enhance functioning of mature cells of immune system (kill cancer cells), enhance RBC and platelet counts in those with bone marrow suppression, and allows higher doses of chemotherapy - FDA Warning: Epoetin: Increased AE when used by patients with higher hemoglobin (heart attack/failure, stroke, and death)

Heparin (Anticoagulant Prototype)

- Indications: Prophylactic for DVT, PE, and DIC - MoA: Inactivates clotting factors, inhibit the conversion of prothrombin to thrombin, and inhibit platelet aggregation - AE/Contraindications: GI ulcers, bleeding, blood dyscrasias, renal/hepatic, severe HTN, hemorrhage, and HIT (toxicity) - aPTT should be maintained approximately 1.5 to 2.5 times the baseline value (45-70s), draw blood 1hr before admin, check platelets everyday, short half life of 1-2hr, and give IV or SubQ because GI cannot absorb - Antidote: Protamine Sulfate

Bleomycin/Blenoxane (Cytotoxic Antitumor Antibiotic Prototype)

- Indications: Squamous cell carcinoma, Hodgkin's/non-Hodgkin's lymphomas, and testicular carcinoma - MoA: Inhibits DNA, RNA, and protein synthesis in susceptible cells, preventing cell division (active in all phases of cell cycle) - Contraindications: Same as daunorubicin - AE: Pulmonary toxicity, BMS (burning mouth), N&V, alopecia, mucositis, and hypoTN

Enoxaparin/Lovenox (LMWH Anticoagulant)

- Indications: Synthetic heparin, lowers adverse effects, post-op DVT or PE, unstable angina management, and prevent MI - MoA, Contraindications, Antidote: Same as heparin - AE: Hemorrhage with less incidence of HIT - Do not need to monitor labs (watch PTT and platelets), given SubQ, longer acting, and more predictable response

NSAIDs' MoA, Uses, and Contraindications

- Inhibit prostaglandin synthesis in CNS/PNS, inhibit COX 1&2, relieve pain by acting centrally or peripherally to block pain impulse, and relieve fever by decreasing hypothalamic response and resetting "thermostat" to lower level > Aspirin and nonselective NSAIDs have antiplatelet effect - Used to prevent/treat mild to moderate pain and inflammation (DJD, OA, RA, and bursitis), reduce fever, and suppress platelet aggregation > Acetaminophen is NOT a NSAID, lacking platelet and anti-inflammatory properties, so it used as analgesic > Aspirin NOT used with children d/t risk of Reye's Syndrome - Contraindications: Increased risk of serious GI events (bleeding, ulceration, perforation), peptic ulcer disease, GI bleeding disorders, and impaired renal function

Ezetimibe/Zetia (Cholesterol Absorption Inhibitor)

- Inhibits cholesterol absorption and related sterols from small intestine, resulting in reduced total cholesterol, LDL, and triglycerides with increased HDL - Often combined with statin (only recommended when patients have not responded to other therapy)

Clotting Cascade

- Intrinsic: Sickle cell anemia, hereditary spherocytosis, and G6PD deficiency - Extrinsic: Drug induced anti-RBC antibodies, septic shock (DIC), and mechanical forces (medical devices) > Leads to RBC destruction, which results in hemolytic anemia

Antiviral Drugs

- Kill/suppress virus by destroying virions or inhibiting replication - IGs are concentrated antibodies that attack/destroy virsues - Key characteristics include ability to enter cells infected with virus, interfere with viral nucleic acid synthesis, interfere with ability of virus to bind , and stimulate immune system - MoA: Inhibit viral replication and reat influenza, HSV (1=oral & 2=genital), VZV/HHV-3(chickenpox), CMV/HHV-5, and hepatitis A-C

Guaifenesin/Mucinex (Expectorant Prototype)

- Liquefy respiratory secretions to allow for easier removal in people with productive coughs - MoA: Reduces viscosity of secretions by irritating gastric vagal receptor stimulating respiratory tract fluid (increase volume) - AE: Hypersensitivity, skin rash, headache, and N&V - Sustained release tablet (do NOT chew)

Antifibrinolytic Drugs

- Prevent lysis of fibrin, resulting in promoting clot formation - Used for prevention/treatment of excessive bleeding resulting from hyperfibrinolysis - Treatment of hemophila or von Willebrand's disease > Hemophilia A (most common w/ insufficient clotting factor VIII), B (insufficient clotting factor IX), and C (insufficient clotting factor XI) - Amicar and desmopressin (DDAVP) used > DDAVP is similar to ADH (antidiuretic) and treatment of diabetes insipidus (sodium increase=excessive urination)

Bile Sequestrants

- Prevents resorption of bile acids from small intestine (less bile = less cholesterol absorbed) > Binds to intestinal bile acids - Used for Type 2 hyperlipoproteinemia (may be used with statins) - Drugs: Cholestyramine (Questran), Colestipol (Colestid), and Colesevelam (Welchol)

Microbial Mechanisms of Resistance

- Production of enzymes that inactivate drugs - Modification of antibiotic target sites - Production of alternate enzyme to bypass ATB activity - Changing cell wall permeability - Acquiring/increasing ability to pump drugs out of cell

Hydroxychloroquine/Plaquenil (Antimalarial)

- Prophylaxis and treatment of malaria, RA/lupus, and prevents CM - Contraindications: Hypersensitivity to 4-aminoquinolone compounds and presence of visual field changes - AE: Visual disturbance, difficulty focusing, prolong QRS interval, hypoTN, GI, rashes, pruritis, hair loss, otoxocity, and weakness

Albuterol/Proventil (Adrenergic Bronchodilator Prototype)

- Short acting for asthma attacks - MoA: Stimulate only beta 2 adrenergic receptors in smooth muscle > Stimulates adenyl cyclase to increase production of cyclic AMP, leading to bronchodilation - Contraindications: Cardiac tachydysrythmias and severe coronary artery disease - AE: Muscle tremor (most common) and major AE are excessive cardiac or CNS stimulation - Use drug before another bronchodilator drug, rinse mouth with H2O after each use, and use spacer device if there is difficulty

Anticholinergics: Ipratropim (Prototype)

- Slow and prolonged action used to prevent bronchoconstriction (NOT used for acute asthma exacerbation) - Ipratropim/Atrovent: Inhalation for maintenance therapy of bronchoconstriction associated with asthma, chronic bronchitis, emphysema, and rhinorrhea (common cold) > MoA: Blocks muscarinic AcH receptors in smooth muscles of bronchi and lungs, inhibiting bronchoconstriction and drying up mucus > Contraindications: Narrow angle glaucoma, prostatic hypertrophy, and bladder neck obstruction > AE: Cough, nervousness, nausea, GI upset, headache, and dizziness > Absorption is poor with few systemic effects

Antifungal Drugs

- Systemic (amphotericin B, caspofungin, fluconazole, ketoconazole) OR topical (clotrimazole, miconazole, nystatin) - Polyenes (Amphotericin B & Nystatin): Bind to sterols in cell membrane lining and result is fungal death - Imidazoles (Ketoconazole) & Triazoles (Fluconazole/Diflucan): Inhibit fungal cell cytochrome P450 enzymes, resulting in cell membrane leaking and altered cell membrane (final result is altered cellular metabolism and fungal death) - Echinocandins (Capsofungin & Micafungin): Prevent synthesis of glucans (fungal cell wall components), leading to fungal cell death - Monitor VS receiving IV infusion every 15-30 minutes and monitor I&O to identify AE

Antitubercular Drug Therapy

- TB caused by mycobacterium tuberculosis (common infection sites include lung, brain, bone, liver, and kidney) - Tubercle bacilli transmitted by droplets expelled by coughing or sneezing, gain entry by inhalation, spread to body organs by blood and lymphatic systems, and become dormant/walled off by calcified or fibrous tissue - Used for prophylaxis and treatment of TB - Considerations: Perform drug susceptibility test on first mycobacterium isolated from patient to prevent development of MDR-TB, problems occur due to non-adherence to drug therapy (increased resistance), and even before test results are known, begin regiment with multiple antitubercular drugs (reduces chances of resistance) - MoA: Protein wall synthesis inhibitors (streptomycin, kanamycin, capreomycin, rifampin, rifabutin), cell wall synthesis inhibitors (cycloserine, ethionamide, isoniazid), and others - Therapy may last 24 months, take medication everyday at same time, emphasize strict adherence to regimen, and do not consume alcohol

Dyslipidemia

- Triglycerides & Cholesterol: Two primary forms of lipids and water-insoluble fats bound to apolipoproteins - Lipoproteins: Combination of triglyceride or cholesterol with apolipoprotein (LDL is bad and HDL is good/used to recycle cholesterol) - NCEP 3 Treatment: Total serum cholesterol, LDL/HDL, triglycerides, and treatment based on total serum and LDL risk factors for CVD - Risk of CHD with cholesterol levels of 300mg/dL is 3-4x higher than 200mg/dL

Acyclovir/Zovirax (Herpes)

- Used for HSV 1&2, VZV, and CMV > Drug of choice for treatment of initial and recurrent episodes - MoA: Inhibits DNA polymerase, interrupting viral DNA replication - Contraindications: Heart failure, renal disease (decrease dose according to CrCl), and lactation - AE: Malaise, headache, N&V, and diarrhea (toxicity includes renal failure and encephalopathy)

Diphenyhydramine/Benadryl (First Gen Antihistamine Prototype)

- Used for hypersensitivity RXN (allergic rhinitis, conjunctivitis, dermatitis), motion sickness, insomnia, and parkinsonism - MoA: Prevent histamine from binding to H1 receptors inhibiting permeability, edema, constriction, and pruritis - Contraindications: Pregnant, narrow angle glaucoma, prostatic hypertrophy, peptic ulcer, and bladder neck obstruction - AE: CNS depression, drowsiness, and drying anticholinergic effects

Pseudophedrine/Sudafed (Adrenergic Nasal Decongestant)

- Used to temporarily releive symptoms associated with nasal congestion (common cold, allergies, sinuses) - MoA: Acts on adrenergic receptors to release NE, produces vasoconstriction, and shrink mucosa allowing drainage - Contraindications: Atopic children - AE: Adrenergics (nervousness, tremor, insomnia, and palpitations) and steroids (local mucosal dryness and irritation) - Caffeine enhances effects, do not crush (extended release), rebound nasal swelling for long term OTC use, and delayed onset compared to intranasal - Topical intranasal steroids include beconase, budesonide (rhinocort), flunisolide (nasalide), fluticasone (flonase), triamcinolone (nasacort), and ciclesonide (omnaris)

Prostaglandins

Chemical mediators found in most body tissues used to assist regulating body functions, participate in inflammatory response, formed when cellular injury occurs, and exert effects on body tissues > NSAIDs are anti-prostaglandins

Fourth & Fifth Generation Cephalosporins

4. Cefepime (Maxipime): Indicated for use in sepsis (lower respiratory tract, urinary tract, skin/soft tissue, and female reproductive tract) 5. Ceftaroline (Teflaro): IV drug used for treatment of community-acquired pneumonia and skin infections > First cephalosporin considered active against resistant gram-positive organisms (MRSA, VRSA, and VISA)

Neuraminidase Inhibitors: Oseltamivir (Tamiflu) & Zanamivir (Relenza)

Active against influenza A & B and reduces duration of illness > AE: O causes N&V whereas Z caues diarrhea, nausea, and sinusitis - Treatment should begin within 2 days of influenza symptom onset

Antimicrobial Mechanisms of Action

Acts on specific target in pathogen to inhibit bacterial wall synthesis, protein synthesis (production of abnormal bacterial proteins), reproduction of organisms, and cell metabolism/growth > Disruption of microbial cell membranes > Sulfonamides: Block synthesis for cell metabolism and growth (antimetabolites) > Penicillins, cephalosporins, and vancomycin inhibit formation of cell wall > Aminoglycosides, macrolides, ketolides, tetracyclines, linezolid, and quinupristin/dalfopristin bind to ribosomes and inhibit production of proteins > Fluoroquinolones inhibit DNA gyrase (reproduction enzyme)

Azathioprine/Imuran (Cytotoxic Immunosuppressant Agent)

Adjunct for prevention of kidney rejection and treatment of RA - MoA: Antimetabolite agent interfering with production of cellular DNA and RNA (blocks cellular reproduction, growth, and development) - Contraindications: Pregnancy and lactation (extreme caution with hepatic impairment) - AE: GI effects, risk of malignancy, infection, latent TB or Hep B may become active, and hepatotoxicity w/ post-transplant venoocclusive liver disease - Obtain baseline liver function and pregnancy test before therapy, low doses in renal disease, and CBCs/liver function tests on set schedule

Antimalarial Drugs

Attack parasite during asexual phase when vulnerable - Erythrocytic Phase: Chloroquine, hydroxychloroquine, quinine, mefloquine, and pyrimethamine > MoA: Bind to parasite nuceloproteins and interfere with protein synthesis, alter pH within parasite, and interfere with parasite's ability to metabolize/use erythrocyte hemoglobin > Primaquine: Kills parasite in both phases (binds/alters parasitic DNA) > May be used with a sulfonamide, clindamycin, or tetracycline for synergistic/additive killing power - NI: Assess presence of malarial symptoms, drugs should be started 1-2 weeks before potential exposure and 4 weeks after leaving area, and drugs taken weekly with 8oz of H2O

Asthma

Bronchoconstriction narrows airway, inflammation, and hyperactivity to stimuli (GERD association) > Symptoms include dyspnea, wheezing, chest tightness, cough, and sputum production

Gancylovir/Cytovene (CMV)

CMV retinitis (ophthalmic form surgically implanted [Vitrasert]) - MoA: Changes substrate that inhibits binding of deoxyguanosine triphosphate to DNA polyermase, which inhibits viral DNA synthesis - Contraindications: Renal impairment, neutrophil count <500/mm3, or platelet count <25000/mm3 - AE: Chills , fever, pruritis, N&V, neuropathy, hematuria, sepsis, and retinal detachment - STOP using if bone marrow suppression occurs and administer slowly - Other Drugs: Foscarnet/Cidofovir: Renal toxicity

Penicillins (Beta-Lactam)

CWS/Bactericidal - MoA: Enter bacterial via cell wall, bnd to pencillin-binding protein, disrupt cell wall synthesis, and kill bacteria cells from cell lysis - Indications: Prevention treatment of infections caused by gram-positive bacteria (streptococcus, enterococcus, and staphylococcus) - AE: Allergic reactions (urticaria, pruritus, angioedema), increased risk to other beta-lactam antibiotics if allergic, and patients with history of throat swelling/hives from penicillin should NOT receive cephalosporin

Cephalosporins (Beta-Lactam)

CWS/Bactericidal - Semisynthetic antibiotics structurally and pharmacologically related to penicillins (broad spectrum) > Assess for penicillin allergy (cross allergy) and give orally with food to decrease GI upset (delays absorption) - First Generation: Good gram positive coverage, bad gram negative coverage, and parenteral/PO forms > Used for surgical prophylaxis and for susceptible staphylococcal infections - Second Generation: Good gram positive coverage and better gram negative coverage - Third Generation: Most potent group against gram negative bacteria, but less active against gram positive bacteria - Fourth Generation: Broader spectrum of antibacterial activity than third generation, especially against gram positive bacteria (UTIs)

Protozoa Infections: Malaria

Caused by plasmodium protozoa through bite of infected adult female anopheline mosquito (can be passed via blood, congenitally, or from infected needles) > Drugs are only effective during asexual cycle > Asexual Cycle: Exoerthyrocytic Phase (occurs outside erythrocyte [tissue phase]) AND erythrocytic phase (inside [blood phase]) - Patients with compromised immune system (immunosuppressive drugs after transplant, leukemia, and AIDS) are at risk

Immune System

Defends body against invading pathogens, foreign antigens, and own cancerous cells > Can attack itself (autoimmune or immune-mediated disease) > Responsible for rejection of kidney, liver, and heart transplants

Salmeterol/Serevent (Adrenergic Bronchodilator)

Prophylaxis for acute bronchoconstriction, not effective in attacks, and inhalation powder - MoA: Long acting beta 2 adrenergic agonists for bronchodilation (stimulate smooth muscle receptors) - Same contraindications and AE as albuterol - Slow onset, maintenance drug and effects last 12hrs (do NOT take frequently) - Other Drugs: Formoterol (Foradil)

Antitubercular Drugs

FIRST LINE: - Isoniazid (INH): TB drug of choice, bactericidal, resistant straisn of mycobacterium emerging, metabolized in liver, contraindicated with liver disease, and AE includes hepatotoxicity and peripheral neuropathy (pyridoxine B6 combats this) - Ethambutol (Myambutol): AE include retrobulbar neuritis and blindness - Rifampin (Rifadin): Often given with INH, brown, AE includes hepatitis, discoloration of urine, stools, and other body fluids (reddish orange is normal) > Stains contact lenses and decreases effectiveness of oral contraceptives - Streptomycin-Aminoglycoside/TB SECOND LINE: Amikacin and levofloxacin

Hematopoiesis

Formation of blood cells: RBC, WBC, and platelets > RBC: Manufactured in bone marrow, immature RBCs (reticulocytes), and life span of 120 days > More than 1/3 of RBC is made of hemoglobin (heme is red/iron and globin is protein chain) > Chronic kidney disease > suppressed bone marrow > anemic

Ribavirin/Virazole (RSV)

Given orally or inhaled (effective in infants/children with severe RSV of lower respiratory tract) - MoA: Inhibits replication of RNA and DNA viruses to stop RNA polymerase activity - Contraindications: Pregnancy BBW (teratogenic effects) - AE: Fatigue, insomnia, headache, anemia, nausea, and anorexia - Discard SPAG-2 unit after 24hrs or when it is low

Histamine vs. Antihistamine

Histamine: > CV (Small Blood Vessels): Dilation and increased permeability (substances leak into tissues) > Immune: Mast cells release histamine, resulting in allergic RXN Antihistamine: > CV: Reduce dilation of blood vessels and reduced permeability > Immune: Binds to histamine receptors, preventing histamine from responding > AE: Anticholinergic effects are most common (dry mouth, difficulty urinating, constipation, and changes in vision) and drowsiness

Filgrastim/Neupogen (G-CSF Prototype)

Granulocyte colony-stimulating factor that stimualtes precursor cells for granulocytes (WBCs) - Indications: Preventing infections in pts w/ neutropenia d/t chemotherapy or bone marrow transplantation (mobilize stem cells from bone marrow to peripheral blood) - MoA: Stimulate production, maturation, and activation of neutrophils within bone marrow - Contraindications: Hypersensitivity to drug and E.coli-derived proteins - AE: Drowsiness, fatigue, flu-like symptoms, nausea, and bone pain - Should not be given within 24 hours of myelosuppressive antineoplastic therapy (sargramostim/leukine antagonize) - Other Drugs: Pegfilgrastim (Neulasta): Longer acting form

Metabolic Syndrome

Group of CV risk factors linked with obesity such as increased waist circumference, triglycerides, BP, and fasting glucose (decreased HDL)

Coagulation Disorders

Hemostasis: Prevention or stoppage of blood loss from an injured blood vessel - process that maintains the integrity of the vascular compartment > When a clot is being formed, plasminogen, an inactive protein present in many body tissues and fluids, is bound to fibrin and becomes a component of the clot > Plasmin (fibrinolysin) is an enzyme that breaks down the fibrin meshwork that stabilizes the clot (dissolves clot) - Arterial Thrombosis: Antherosclerotic plaque, hypertension, and turbulent blood flow (can cause disease by obstructing flow and local tissue ischemia)

Ciprofloxacin (Fluoroquinolone Prototype)

Most potent against gram negative and first line treatment for anthrax/meningitis - MoA: Bactericidal interfering with enzymes required for synthesis of bacterial DNA (necessary for bacterial growth and replication) - Contraindications: Pregnancy (unless benefits outweigh) and use of tiazanide - AE: Frequent GI SX, photosensitivity, and tendon rupture/tendonitis - Other Drugs: Levofloxacin (Levaquin): Pneumonia

Tetracyclines

Natural and semisynthetic antibiotic derived from chlortetracycline that is effective against gram+&- and is bacteriostatic (not drug of choice) > Used against organisms such as protozoa, mycoplasma, rickets, chlamydia, syphilis, lyme disease, acne, etc. - Obtained from cultures of streptomyces, inhibits protein synthesis, stop essential functions of bacteria, and binds (chelate) to Ca++, Mg++, and Al+++ ions to form insoluble complexes - AE: Vaginal candidasis, gastric upset, enterocolitis, maculopapular rash, etc. > Avoid dairy products, antacids, and iron salts reduce oral absorption and chelation/drug binding occurs > Avoid sunlight and tanning beds due to photosensitivity - Should NOT be used in children or pregnant/lactating women because tooth discoloration will occur if drug binds to calcium in teeth

Aminoglycosides

Natural and semisynthetic antibiotic produced from streptomyces with poor oral absorption via GI tract and no PO forms (except neomycin) > Very potent, bactericidal (prevent protein synthesis), and kill mostly gram negative bacteria (pseudomonas, E.coli, proteus, klebsiella, and serratia) and some gram positive > Used in combination with other antibiotics for synergistic effects - AE: Nephrotoxicity (renal damage), ototoxic CN VIII (monitor drug levels),

Leukotriene Receptor Antagonists (LTRAs)

Newer class of asthma medications (EX: Montelukast & Zafirlukast) that are nonbronchodilating > Prevent leukotrienes from attaching to receptors on cells in lungs and in circulation > Inflammation in lungs blocked and asthma symptoms relieved > Long-term treatment of asthma and prevent acute asthma attacks caused by allergens, exercise, cold air, hyperventilation, irritants, and NSAIDs (not effetive in relieving acute attacks)

Sulfonamides

Older, broad spectrum, bacteriostatic drugs rarely used in systemic infection due to resistance and development of more effective/less toxic drugs - Effective against gram +/- and used for treatment of UTIs (enterobacter, E.coli, klebsiella, proteus mirabilis/vulgaris, and staph aureus), PJP (co-trimoxazole), and upper resp. tract infections > Sulfamethoxazole combined with trimethoprim (a nonsulfonamide drug) known as bactrim, septra, or co-trimoxazole (SMX-TMP) often used in clinical practice

Chemotherapy

Pharmacological treatment of cancer with use of antineoplastic drugs > Divided into two groups based on works of cellular life cycle: cell cycle-nonspecific (CCNS) or cell cycle-specific (CCS) > AE: Dose limiting AE (GI and bone marrow), alopecia, emesis, myelosuppression (bone marrow), extravastation, and Nadir-WBC decrease (7-14 days after start)

Oprelvekin/Neumega (Cytoprotectant IL)

Platelet-promoting drug - Indications: Thrombocytopenia in oncology and reduce need of platelet transfusions in cancer pts receiving myelosuppressive chemotherapy > Ineffective in severe thrombocytopenia (highly toxic) - MoA: IL-11 stimulator of platelet production

Antiplatelet Drugs

Prevent platelet adhesion - Includes aspirin, clopidogrel/plavix (ticagrelor/brilinta is similar), triofiban/aggrastat, eptifibatide/integrilin, and abciximab/reopro (last 3 are GP IIb/IIIa inhibitors)

Immunosuppressants

Primarily indicated for prevention of organ rejection (can be used for RA or MS) - Muromonab-CD3 (Orthoclone): Only drug indicated for reversal of organ rejection once rejection of transplanted organ begins - Cyclosporine (Sandimmune): Primary drug used for prevention of kidney, liver, heart, and bone marrow transplant rejection - Tacrolimus (Prograf): Used for prevention of liver and kidney transplant rejection - Glatiramer Acetate (Copaxome): Immunosuppressant drug used for MS (opportunistic infections) - Other Drugs: Corticosteroids and sirolimus (rapamune)

Dalteparin/Fragmin (LMWH Anticoagulant)

Prophylaxis of DVT in patients having hip replacement surgery and patients with high risk for thrombolytic disorders who are having abdominal surgery

Types of Penicillins

Prototype: Ampicillin (Principen) - Natural Penicillins (not commonly used due to allergies) limited number of effective uses: Penicillin G (IV administration may result in cardiopulmonary arrest and death) AND Penicillin V - Penicillinase-Resistant Penicillins: Cover mutated organisms (used for methicillin-susceptible Staph aureus): Nafcillin, Cloxacillin, Oxacillin, and Dicloxacillin - Aminopenicillins: Prevention of bacterial endocarditis and more useful in some UTIs (treatment of bronchitis, sinusitis, and OM) > Amoxicillin/Amoxil (children w/ ear infections) and Ampicillin (Principen) - Extended-Spectrum Penicillins: Carbenicillin, Piperacillin, Ticarcillin

Carbapenems

Prototype: Imipenem-Cilastatin (Primaxin) - Used for treatment of bone, joint, skin, and soft tissue infections - Cilastatin inhibits enzyme that breaks down imipenem > Other Drugs: Meropenem (Merram), Ertapenem (Invanz), and Doripenem (Doribax)

Bronchodilators (S/LABA)

Relax bronchial smooth muscle, which causes dilation of bronchi and bronchioles that are narrowed as a result of the disease process - Short-Acting Beta Adrenergic Agonist Inhalers: > Albuterol (Ventolin), Levalbuterol (Xopenex), Metaproterenol (Alupent), and Terbutaline (Brethine) - Long-Acting: Salmeterol (Serevant) - Used during acute phase of asthma attacks to reduce airway constriction and restore normal airflow (SNS)

Epoetin Alfa/Epogen (Erythrocyte Hematopoietic Drug Prototype)

Synthetic derivative of erythropoiertin - Indications: Anemia associated with chronic renal failure, hepatic impairment, or anticancer chemotherapy (reduces need for blood transfusions) - MoA: Erythropoiesis by stimulating erythroid progenitor cells (affects bone marrow increase in hemoglobin and hematocrit) - Contraindications: Hypersensitivity to albumin and uncontrolled HTN - AE: HTN (raising hemoglobin slowly minimizes), N&V, diarrhea, and arthralgias - Hemoglobin levels no more than 12 (risk of MI/stroke over 12), measure iron stores before/during tx, and HGB measured 2x weekly until stable - Other Drugs: Darbepoetin Alfa (Aranesp): Longer acting form used to stimulate RBC production

Amphotericin B (Antifungal Polyene Prototype)

Severe systemic (progressive/fatal) fungal infections - Contraindications: Lactation and renal impairment - AE: Multiple organ failure, cardiac arrest, resp. arrest, nephrotoxicity, and neurotoxicity (seizures/paresthesias) > Gives aspirin, tylenol, antihistamines, corticosteroids, and antemetics to manage AE (use IV infusion pumps)

Dextromethorphan/Robitussin DM (Antitussive Prototype)

Suppress nonpurposeful (not productive) coughing > dry, hacking cough interfering with rest - MoA: Depresses cough center in medulla/receptors in throat, trachea, or lungs, elevating threshold for coughing - Contraindications: Atopic children d/t histamine release - AE: Nausea, drowsiness, rash, difficulty breathing, and hallucinations/disassociation (high doses)

Fluoroquinolones

Synthetic antibiotic drugs with activity against gram-/+(some), given PO (excellent oral absorption), and absorption reduced by antacids - MoA: Bactericidal altering bacteria DNA, causing death - Used for gram- organisms such as Pseudomonas, complicated UTI, respiratory, bone/joint, GI, skin, and sexually transmitted infections

Aztreonam/Azactam (Monobactam)

Synthetic beta-lactam antibiotic primarily active against aerobic gram-negative bacteria (EX: E.coli, Klebsiella, and pseudomonas) > Bactericidal, parenteral use only, and used for moderately severe systemic infections/UTIs

Antimicrobial Medications

Used to treat or prevent infections caused by pathogens and are necessary when host defense cannot ward off infection > Normal microbial flora are on skin, upper respiratory tract, and colon > Infectious disease involve presence of pathogen plus clinical signs+symptoms of infections > Opportunistic pathogens become pathogenic with impaired defenses such as severe burns, CA, HIV, indwelling IV or urinary catheters, and antibiotic/corticosteroid therapy > Lab tests can identify bacteria using gram stain (microscopic appearance), culture (growing microbes), serology (ID via antibody levels), and PCR (detects microbial DNA)