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| − | <h2>Key concepts</h2>
| + | ''This article is not yet considered complete'' |
| − | <p>This chapter will cover the following knowledge areas to prepare you for the <em>Pharmacy Technician Certification Exam</em>:</p>
| + | |
| − | <ul>
| + | This article is intended to provide a broad overview of pharmacology and medications often used in either community or institutional pharmacy settings and is not intended as sole means towards determining diagnosis and/or treatment of an individual. |
| − | <li>Generic and brand names of pharmaceuticals</li>
| + | |
| − | <li>Therapeutic equivalence</li>
| + | This article will cover the following knowledge areas: |
| − | <li>Drug interactions (e.g., drug-disease, drug-drug, drug-dietary supplement, drug-OTC, drug-laboratory, drug-nutrient)</li>
| + | *Generic and brand names of pharmaceuticals |
| − | <li>Strengths/dose, dosage forms, physical appearance, routes of administration, and duration of drug therapy</li>
| + | *Therapeutic equivalence |
| − | <li>Common and severe side or adverse effects, allergies, and therapeutic contraindications associated with medications</li>
| + | *Drug interactions (e.g., drug-disease, drug-drug, drug-dietary supplement, drug-OTC, drug-laboratory, drug-nutrient) |
| − | <li>Dosage and indication of legend, OTC medications, herbal and dietary supplements</li>
| + | *Strengths/dose, dosage forms, physical appearance, routes of administration, and duration of drug therapy |
| − | </ul>
| + | *Common and severe side or adverse effects, allergies, and therapeutic contraindications associated with medications |
| − | <h2>Terminology</h2>
| + | *Dosage and indication of legend, OTC medications, herbal and dietary supplements |
| − | <p>To get started in this chapter, there are some terms that should be defined.</p>
| + | |
| − | <p><strong>pharmacology</strong> - The term pharmacology is derived from to Greek words "pharmakon" and "logos". Pharmakon can mean sacrament, remedy, poison, talisman, cosmetic, perfume or intoxicant, but in this case it can be broadly defined as drug. Logos can be translated as a principle of order and knowledge. By combining the terms you can see that pharmacology is concerned with the knowledge of drugs.</p>
| + | ==Terminology== |
| − | <p><strong>OTC</strong> - Over the counter medications are drugs that do not require the use of a prescription for a patient to obtain it. These medications are generally considered sufficiently safe for a patient to acquire and self medicate with by following the instructions included on the vial.</p>
| + | |
| − | <p><strong>legend</strong> - Legend drugs are medications that require a prescription prior to dispensing. These medications may or may not be considered abusable, but consultation with a medical professional that has prescribing authority is necessary due to the complex health conditions that these medications may be able to treat or ameliorate. Often, you will see the phrase "Rx only" used to denote legend drugs.</p>
| + | To get started in this chapter, there are some terms that should be defined. |
| − | <p><strong>controlled substances</strong> - Controlled substances are medications with restrictions due to abuse potential. There are 5 schedules of controlled substances with various prescribing guidelines based on abuse potential counter balanced by potential medicinal benefit as determined by the Drug Enforcement Administration and individual state legislative branches.</p>
| + | |
| − | <p><strong>brand name</strong> - This is the manufacturers trademark designation. Each brand name is owned by the company and begins with a capital letter, and it is protected by a trademark. Drugs often have several brand names. The terms trade name and proprietary name may also be used interchangeably with brand name.</p>
| + | '''pharmacology''' - The term pharmacology is derived from to Greek words "pharmakon" and "logos". Pharmakon can mean sacrament, remedy, poison, talisman, cosmetic, perfume or intoxicant, but in this case it can be broadly defined as drug. Logos can be translated as a principle of order and knowledge. By combining the terms you can see that pharmacology is concerned with the knowledge of drugs. |
| − | <p><strong>generic name</strong> - This is the official non-proprietary name assigned by the manufacturer with the approval of the USAN (United States Adopted Name) Council. The Federal Food and Drug Administration (FDA) requires that each drug has a generic name even if currently it is only available as a brand name product. A generic name may also be referred to as the non-proprietary name.</p>
| + | |
| − | <p><strong>therapeutic equivalents</strong> - Drug products are considered to be therapeutic equivalents only if they are available in the same dosage strength, dosage form, achieve the same blood levels, and if they can be expected to have the same clinical effect and safety profile when compared to the original innovator drug. To ensure that a specific generic product is considered to be a therapeutic equivalent, it is recommended that you refer to the Orange Book, a publication from the Food and Drug Administration (FDA). If the the products being compared in the Orange Book are considered therapeutic equivalents, it will be given a Therapeutic Equivalence (TE) Code of "A". If the products are not considered therapeutic equivalents, they will be given a TE Code of "B". Sometimes these will be referred to as "A" ratings and "B" ratings.</p>
| + | '''OTC''' - Over the counter medications are drugs that do not require the use of a prescription for a patient to obtain it. These medications are generally considered sufficiently safe for a patient to acquire and self medicate with by following the instructions included on the vial. |
| − | <p><strong>classification</strong> - This is how a medication is grouped and is typically defined according to its use in treating a particular disease or disorder. A potential source of confusion is that many medications could be grouped multiple ways. An example of this it aspirin can be classified as an analgesic, antipyretic, and anti-inflammatory agent.</p>
| + | |
| − | <p><strong> indication</strong> - This is the primary condition(s) treated by a particular drug. This may include both FDA approved uses as well as off-label (generally based on scientific studies but lacking FDA approval) medication uses.</p>
| + | '''legend''' - Legend drugs are medications that require a prescription prior to dispensing. These medications may or may not be considered abusable, but consultation with a medical professional that has prescribing authority is necessary due to the complex health conditions that these medications may be able to treat or ameliorate. Often, you will see the phrase "Rx only" used to denote legend drugs. |
| − | <p><strong>dosage form</strong> - A dosage form is the physical form of a dose of medication, such as capsule, patch, or injection. The route of administration is dependent on the dosage form of a given drug. As an example, persistent vomiting may make it difficult to use an oral dosage form, therefore an antiemetic in suppository form may be desirable.</p>
| + | |
| − | <p><strong>interactions</strong> - Medications have the potential to interact with other medications, dietary supplements, and constituents of various foods. Medications may also interact with various diseases.</p>
| + | '''controlled substances''' - Controlled substances are medications with restrictions due to abuse potential. There are 5 schedules of controlled substances with various prescribing guidelines based on abuse potential counter balanced by potential medicinal benefit as determined by the Drug Enforcement Administration and individual state legislative branches. |
| − | <p><em>Quick review question 1</em></p>
| + | |
| − | <p>The following is not a synonym for the term brand name?</p>
| + | '''brand name''' - This is the manufacturers trademark designation. Each brand name is owned by the company and begins with a capital letter, and it is protected by a trademark. Drugs often have several brand names. The terms trade name and proprietary name may also be used interchangeably with brand name. |
| − | <p> a. trade name<br /> b. proprietary name<br /> c. non-proprietary name</p>
| + | |
| − | <p><em>Quick review question 2</em></p>
| + | '''generic name''' - This is the official non-proprietary name assigned by the manufacturer with the approval of the USAN (United States Adopted Name) Council. The Federal Food and Drug Administration (FDA) requires that each drug has a generic name even if currently it is only available as a brand name product. A generic name may also be referred to as the non-proprietary name. |
| − | <p>What does it mean if you compare two products in the Orange Book and get a TE Code of "B"?</p>
| + | |
| − | <p> a. The two medications are considered therapeutic equivalents and can be safely interchanged with each other<br /> b. There is a therapeutic equivalence problem.<br /> c. The generic product has a grade range of 80-89%<br /> d. There is no such thing as a TE Code of "B"</p>
| + | '''therapeutic equivalents''' - Drug products are considered to be therapeutic equivalents only if they are available in the same dosage strength, dosage form, achieve the same blood levels, and if they can be expected to have the same clinical effect and safety profile when compared to the original innovator drug. To ensure that a specific generic product is considered to be a therapeutic equivalent, it is recommended that you refer to the Orange Book, a publication from the Food and Drug Administration (FDA). If the the products being compared in the Orange Book are considered therapeutic equivalents, it will be given a Therapeutic Equivalence (TE) Code of "A". If the products are not considered therapeutic equivalents, they will be given a TE Code of "B". Sometimes these will be referred to as "A" ratings and "B" ratings. |
| − | <h2>Common medications</h2>
| + | |
| − | <p>Pharmacy technicians should be able to categorize drugs into major therapeutic classifications and be able to briefly describe the therapeutic use of each drug. Technicians should also be able to correlate brand name medications with the generic names.</p>
| + | '''classification''' - This is how a medication is grouped and is typically defined according to its use in treating a particular disease or disorder. A potential source of confusion is that many medications could be grouped multiple ways. An example of this it aspirin can be classified as an analgesic, antipyretic, and anti-inflammatory agent. |
| − | <p>The following subsections will break the drugs down into various therapeutic classes with descriptions of these classes followed by a list of generic drug names accompanied by their most common brand names and commercially available dosage forms. These lists are not to be considered comprehensive, but instead just provide some of the more common items to serve as a quick refresher. If you want more information on a particular drug, an excellent free (registration required) resource is Medscape at <a href="http://reference.medscape.com/">http://reference.medscape.com</a>.</p>
| + | |
| − | <h3>Anti-infective agents</h3>
| + | '''indication''' - This is the primary condition(s) treated by a particular drug. This may include both FDA approved uses as well as off-label (generally based on scientific studies but lacking FDA approval) medication uses. |
| − | <p>An anti-infective (also called an antimicrobial) is a substance that kills or inhibits the growth of microbes such as bacteria, fungi, protozoans or viruses. In this section we will look at antibiotics, antifungals, amebicides, and antivirals.</p>
| + | |
| − | <p>Bacteria treated by antibiotics are usually broken into two categories, gram positive and gram negative.</p>
| + | '''dosage form''' - A dosage form is the physical form of a dose of medication, such as capsule, patch, or injection. The route of administration is dependent on the dosage form of a given drug. As an example, persistent vomiting may make it difficult to use an oral dosage form, therefore an antiemetic in suppository form may be desirable. |
| − | <p>Gram-positive bacteria are those that are stained dark blue or violet by Gram staining. This is in contrast to Gram-negative bacteria, which cannot retain the crystal violet stain, instead taking up the counterstain (safranin or fuchsin) and appearing red or pink. Gram-positive organisms are able to retain the crystal violet stain because of the high amount of peptidoglycan in the cell wall. Gram-positive cell walls typically lack the outer membrane found in Gram-negative bacteria.</p>
| + | |
| − | <p><strong>Penicillin Derivatives</strong></p>
| + | '''interactions''' - Medications have the potential to interact with other medications, dietary supplements, and constituents of various foods. Medications may also interact with various diseases. |
| − | <p>Penicillin derivatives act by preventing cell wall synthesis during active replication and are therefore bactericidal. Penicillin derivatives have a chemical structure referred to as a beta-lactam ring which is what allows it to attach to the bacteria. Penicillins are used in the treatment of bacterial infections caused by susceptible, usually Gram-positive, organisms. The most common side effects are allergic reactions including rash, hives, or anaphylactic shock.</p>
| + | |
| − | <p><em>amoxicillin</em> (Amoxil, Moxatag, Trimox) - oral solution, capsule, tablet, chewable tablet, extended-release tablet <br /><em>ampicillin</em> (Principen) - capsules, oral suspension, powder for injection<br /><em>nafcillin</em> (Nafcil) - injectable solution, powder for injection<br /><em>oxacillin</em> (Bactocill) - infusion solution, oral solution, powder for injection<br /><em>penicillin G</em> (Bicillin, Wycillin) - premixed injectable solution, powder for injectable solution<br /><em>penicillin V</em> potassium (Pen Vee K, Veetids) - oral solution, tablet<br /><em>piperacillin</em> (Pipracil) - powder for injection<br /><em>ticarcillin</em> (Ticar) - powder for injection</p>
| + | ==Common medications== |
| − | <p><strong>Penicillin Derivatives with Beta-Lactamase Inhibitors</strong></p>
| + | |
| − | <p>Sometimes bacteria become resistant to penicillin, and one such mechanism of action for them to do that is by creating beta-lactamase which breaks down the beta-lactam ring in penicillins preventing them from attaching to the bacteria walls. There is a chemical class that can prevent this called beta-lactamase inhibitors that are often coupled with penicillins.</p>
| + | Pharmacy technicians should be able to categorize drugs into major therapeutic classifications and be able to briefly describe the therapeutic use of each drug. Technicians should also be able to correlate brand name medications with the generic names. |
| − | <p><em>amoxicillin & clavulanate</em> (Augmentin) - oral suspension, tablet, chewable tablet<br /><em>ampicillin & sulbactam</em> (Unasyn) - injectable solution, powder for solution<br /><em>piperacillin & tazobactam</em> (Zosyn) - powder for injection<br /><em>ticarcillin & clavulanate</em> (Timentin) - powder for injection, infusion solution</p>
| + | |
| − | <p><strong>Carbapenems</strong></p>
| + | The following subsections will break the drugs down into various therapeutic classes with descriptions of these classes followed by a list of generic drug names accompanied by their most common brand names and commercially available dosage forms. These lists are not to be considered comprehensive, but instead just provide some of the more common items to serve as a quick refresher. If you want more information on a particular drug, an excellent free (registration required) resource is Medscape at http://reference.medscape.com. |
| − | <p>Carbapenems are a class of beta-lactam antibiotics with a broad spectrum of antibacterial activity, and have a structure which renders them highly resistant to beta-lactamases.</p>
| + | |
| − | <p><em>ertapenem</em> (Invanz) - powder for injection<br /> <em>imipenem & cilastin</em> (Primaxin) - powder for injection<br /><em>meropenem</em> (Merrem) - powder for injectable solution</p>
| + | ===Anti-infective agents=== |
| − | <p><strong>Cephalosporins</strong></p>
| + | An anti-infective (also called an antimicrobial) is a substance that kills or inhibits the growth of microbes such as bacteria, fungi, protozoans or viruses. In this section we will look at antibiotics, antifungals, amebicides, and antivirals. |
| − | <p>The cephalosporins are bactericidal antibiotics that have chemical structures similar to those of penicillins and therefor have the same mechanism of action. Also, due to their similar chemical structure to penicillin, there is a 7-10% potential of cross sensitivity. The cephalosporins are considered to be broad spectrum drugs. Their two main uses are as substitutes for penicillins in cases of allergy or bacterial resistance and in the treatment of certain gram negative infections.</p>
| + | |
| − | <p><em>cefaclor</em> (Ceclor) - capsule, tablet extended-release<br /><em>cefazolin</em> (Kefzol) - powder for injection<br /><em>cefdinir</em> (Omnicef) - capsule, oral suspension<br /><em>cefepime</em> (Maxipime) - infusion solution, powder for injection<br /><em>cefotaxime</em> (Claforan) - injectable solution, powder for injection<br /><em>cefotetan</em> (Cefotan) - injectable solution, powder for injection<br /> <em>ceftaroline</em> (Teflaro) - powder for injection<br /> <em>ceftazidime</em> (Fortaz) - injectable solution, powder for injection<br /><em>ceftriaxone</em> (Rocephin) - injectable solution, powder for injection<br /><em>cephalexin</em> (Keflex) - capsule, film-coated tablet, oral suspension, tablet for oral suspension</p>
| + | Bacteria treated by antibiotics are usually broken into two categories, gram positive and gram negative. |
| − | <p><strong>Aminoglycosides</strong></p>
| + | |
| − | <p>The aminoglycosides are a group of bactericidal antibiotics whose antibacterial spectrum mainly includes gram-negative bacilli. Aminoglycosides have poor oral absorption, therefore if systemic effects are desired they are usually given IV or IM. Aminoglycosides are both nephrotoxic (kidney) and ototoxic (ear).</p>
| + | Gram-positive bacteria are those that are stained dark blue or violet by Gram staining. This is in contrast to Gram-negative bacteria, which cannot retain the crystal violet stain, instead taking up the counterstain (safranin or fuchsin) and appearing red or pink. Gram-positive organisms are able to retain the crystal violet stain because of the high amount of peptidoglycan in the cell wall. Gram-positive cell walls typically lack the outer membrane found in Gram-negative bacteria. |
| − | <p><em>amikacin</em> (Amikin) - injectable solution<br /><em>gentamicin</em> (Garamycin) - injectable solution, ophthalmic ointment, ophthalmic suspension <br /><em>kanamycin</em> (Kantrex) - injectable solution<br /><em>tobramycin</em> (Nebcin, Tobi, Tobrex) - injectable solution, nebulizer solution, ophthalmic ointment, ophthalmic solution<br /><em>tobramycin & dexamethasone</em> (TobraDex) - ophthalmic ointment, ophthalmic suspension - This is a combination of an aminoglycoside and a corticosteroid.</p>
| + | |
| − | <p><strong>Tetracyclines</strong></p>
| + | ====Penicillin Derivatives==== |
| − | <p>The tetracyclines (a group of broad-spectrum bacteriostatic antibiotics) are clinically useful in both gram-positive and gram-negative infections.</p>
| + | |
| − | <p>When ingested, it is usually recommended that tetracyclines should be taken with a full glass of water, either two hours after eating or one hour before eating. This is partly because tetracycline binds easily with magnesium, aluminum, iron, and calcium, which reduces its ability to be completely absorbed by the body. Dairy products or preparations containing iron are not recommended directly after taking the drug.</p>
| + | Penicillin derivatives act by preventing cell wall synthesis during active replication and are therefore bactericidal. Penicillin derivatives have a chemical structure referred to as a beta-lactam ring which is what allows it to attach to the bacteria. Penicillins are used in the treatment of bacterial infections caused by susceptible, usually Gram-positive, organisms. The most common side effects are allergic reactions including rash, hives, or anaphylactic shock. |
| − | <p>Side effects from tetracyclines are not always common, but of particular note is possible photosensitive allergic reaction which increases the risk of sunburn under exposure to UV light from the sun or other sources. Tetracyclines are teratogens due to the likelihood of causing teeth discoloration in the fetus as they develop in infancy. For this same reason, tetracyclines are contraindicated for use in children under 12 years of age.</p>
| + | |
| − | <p><em>doxycycline</em> (Vibramycin) - capsule, powder for injection, syrup, tablet, delayed-release tablet<br /><em>minocycline</em> (Minocin) - oral suspension, tablet, capsule, extended-release tablet, intravenous injection<br /><em>tetracycline</em> (Sumycin) - capsule, tablet<br /><em>tigecycline</em> (Tygacil) - powder for injection</p>
| + | ''amoxicillin'' (Amoxil, Moxatag, Trimox) - oral solution, capsule, tablet, chewable tablet, extended-release tablet <br /> |
| − | <p><strong>Sulfonamides</strong></p>
| + | ''ampicillin'' (Principen) - capsules, oral suspension, powder for injection<br /> |
| − | <p>Sulfonamides are a group of synthetic bacteriostatic drugs which are effective against both gram-positive and gram-negative infections. Approximately 3% of people using sulfonamides report side effects, the most common of which are hypersensitivity reactions such as rash and hives, but some patients may have more severe reactions.</p>
| + | ''nafcillin'' (Nafcil) - injectable solution, powder for injection<br /> |
| − | <p>Sulfonamides have the potential to crystallize in the kidneys, due to their low solubility. This is a very painful experience, so patients are recommended to take these medication with large amounts of water.</p>
| + | ''oxacillin'' (Bactocill) - infusion solution, oral solution, powder for injection<br /> |
| − | <p><em>silver sulfidiazine</em> (Silvadene) - cream<br /><em>sulfamethoxazole & trimethoprim</em> (Bactrim, Septra, Co-Trimoxazole) - injected solution, oral solution, tablet<br /><em>sulfasalazine</em> (Azulfidine) - tablet, extended-release tablet</p>
| + | ''penicillin G'' (Bicillin, Wycillin) - premixed injectable solution, powder for injectable solution<br /> |
| − | <p><strong>Macrolide Antibiotics</strong></p>
| + | ''penicillin V potassium'' (Pen Vee K, Veetids) - oral solution, tablet<br /> |
| − | <p>The term macrolide refers to the large chemical ring structure that is characteristic of these antibiotics. These antibiotics inhibit bacterial protein synthesis and can be bacteriostatic or bactericidal. Food effects oral absorption of these drugs, although they frequently cause GI problems which may warrant taking them with food. Macrolides may interfere with some medications that require liver biotransformation such as digoxin, warfarin, and cyclosporine therefore a different antibiotic choice may be desirable if a patient is currently using any of those medications.</p>
| + | ''piperacillin'' (Pipracil) - powder for injection<br /> |
| − | <p><em>azithromycin</em> (Zithromax, AzaSite) - oral suspension, powder for injection, powder for oral suspension, extended-release powder for oral suspension, tablet, ophthalmic solution<br /><em>clarithromycin</em> (Biaxin) - oral suspension, tablet, extended-release tablet<br /><em>erythromycin</em> (Erythrocin, E-Mycin) - tablet, delayed-release tablet, dispertab, injection, oral suspension, ophthalmic ointment</p>
| + | ''ticarcillin'' (Ticar) - powder for injection |
| − | <p><strong>Fluoroquinolones</strong></p>
| + | |
| − | <p>The fluoroquinolones, often just called quinolone antibiotics, are synthetic antimicrobial agents that are a broad spectrum bactericidal, especially against gram-negative organisms. A black box warning has been added to all fluoroquinolones involving an increased risk of developing tendinitis and tendon rupture in patients of all ages taking fluoroquinolones for systemic use. This risk is further increased in individuals over 60 years of age, taking corticosteroid drugs, and have received kidney, heart, or lung transplants.</p>
| + | ====Penicillin Derivatives with Beta-Lactamase Inhibitors==== |
| − | <p><em>ciprofloxacin</em> (Cipro) - infusion solution, oral suspension, tablet, extended-release tablet, ophthalmic solution, ophthalmic ointment, otic solution<br /><em>levofloxacin</em> (Levaquin) - injectable solution, premix infusion solution, oral solution, tablet, ophthalmic solution<br /><em>moxifloxacin</em> (Avelox) - injectable solution, tablet, opthalmic solution<br /><em>ofloxacin</em> (Floxin) - tablet, ophthalmic solution, otic solution</p>
| + | |
| − | <p><strong>Miscellaneous Antibiotics</strong></p>
| + | Sometimes bacteria become resistant to penicillin, and one such mechanism of action for them to do that is by creating beta-lactamase which breaks down the beta-lactam ring in penicillins preventing them from attaching to the bacteria walls. There is a chemical class that can prevent this called beta-lactamase inhibitors that are often coupled with penicillins. |
| − | <p>Some common antibiotics are the only drugs in their respective classes. The following listed medications are examples of those. These drugs each have their own side effects and precautions, for example, IV use of vancomycin may cause a reaction known as red man syndrome characterized by flushing and/or rash that affects the face, neck, and upper torso. </p>
| + | |
| − | <p><em>aztreonam</em> (Azactam) - infusion solution, powder for injection<br /><em>clindamycin</em> (Cleocin) - capsule, injectable solution, oral solution, vaginal cream, vaginal suppository<br /><em>daptomycin</em> (Cubicin) - injectable solution<br /><em>linezolid</em> (Zyvox) - injectable solution, oral suspension, tablet<br /><em>mupirocin</em> (Bactroban) - cream, topical ointment, nasal ointment<br /><em>nitrofurantoin</em> (Macrobid) - capsule, oral suspension<br /><em>vancomycin</em> (Vancocin) - capsule, injectable solution, powder for injection</p>
| + | ''amoxicillin & clavulanate'' (Augmentin) - oral suspension, tablet, chewable tablet<br /> |
| − | <p><strong>Antifungals</strong></p>
| + | ''ampicillin & sulbactam'' (Unasyn) - injectable solution, powder for solution<br /> |
| − | <p>An antifungal drug is medication used to treat fungal infections such as athlete's foot, ringworm, candidiasis (thrush), serious systemic infections such as cryptococcal meningitis, and others.</p>
| + | ''piperacillin & tazobactam'' (Zosyn) - powder for injection<br /> |
| − | <p>Antifungals work by exploiting differences between mammalian and fungal cells to kill off the fungal organism without dangerous effects on the host. Unlike bacteria, both fungi and humans are eukaryotes. Thus fungal and human cells are similar at the molecular level. This means it is more difficult to find a target for an antifungal drug to attack that does not also exist in the infected organism. Consequently, there are often side-effects to some of these drugs. Many of these agents are hepatotoxic (liver) and liver function and enzymes must be monitored. It is not uncommon for therapy to last for several months.</p>
| + | ''ticarcillin & clavulanate'' (Timentin) - powder for injection, infusion solution |
| − | <p><em>amphotericin B</em> (Fungizone) - powder for injection, injectable lipid complex, cream, lotion, ointment<br /><em>betamethasone & clotrimazole</em> (Lotrisone) - cream, lotion - This is a combination of a corticosteroid and an antifungal.<br /><em>clotrimazole</em> (Gyne-Lotrimin, Mycelex) - troche, vaginal cream, vaginal tablet, cream, topical solution, lotion, powder<br /><em>fluconazole</em> (Diflucan) - injected solution, oral suspension, tablet<br /><em>nystatin</em> (Mycostatin, Nilstat) - oral powder, oral suspension, oral tablet, troche, cream, ointment, powder, vaginal tablet<br /><em>terbinafine</em> (Lamisil) - tablet, oral granules, cream, topical solution</p>
| + | |
| − | <p><strong>Amebicides</strong></p>
| + | ====Carbapenems==== |
| − | <p>An amebicide (or amoebicide) is an agent used in the treatment of amoebic infections. Alcohol use should be avoided while taking metronidazole because concurrent use may cause nausea, vomiting, flushing of the skin, tachycardia, and shortness of breath.</p>
| + | |
| − | <p><em>metronidazole</em> (Flagyl) - capsule, tablet, extended-release tablet, infusion solution, topical gel, topical cream, topical lotion, vaginal gel<br /><em>pentamidine</em> (Pentam) - powder for injection, powder for nebulizer solution</p>
| + | Carbapenems are a class of beta-lactam antibiotics with a broad spectrum of antibacterial activity, and have a structure which renders them highly resistant to beta-lactamases. |
| − | <p><strong>Antimalarial Drugs</strong></p>
| + | |
| − | <p>Antimalarial drugs are agents used to prevent and cure malaria. Some antimalarial drugs, such as hydroxychloroquine, are also used to treat conditions like rheumatoid arthritis and lupus. One of the most serious side effects is a toxicity in the eye (this primarily occurs with chronic use).</p>
| + | ''ertapenem'' (Invanz) - powder for injection<br /> |
| − | <p><em>hydroxychloroquine</em> (Plaquenil) - tablet<br /><em>quinine sulfate</em> (Qualaquin) - capsule</p>
| + | ''imipenem & cilastin'' (Primaxin) - powder for injection<br /> |
| − | <p><strong>Antivirals</strong></p>
| + | ''meropenem'' (Merrem) - powder for injectable solution |
| − | <p>Antiviral drugs are a class of medication used specifically for treating viral infections. Like antibiotics, specific antivirals are used for specific viruses. They are relatively harmless to the host, and therefore can be used to treat infections. They should be distinguished from viricides, which actively deactivate virus particles outside the body.</p>
| + | |
| − | <p>Most of the antivirals now available are designed to help deal with HIV; herpes viruses, best known for causing cold sores and genital herpes, but actually causing a wide range of diseases; the hepatitis B and C viruses, which can cause liver cancer; and influenza A and B viruses. Researchers are now working to extend the range of antivirals to other families of pathogens.</p>
| + | ====Cephalosporins==== |
| − | <p>Antiviral drugs work by inhibiting the virus ether before it enters the cell, stopping it from reproducing, or in some cases preventing it from exiting the cell. However, like antibiotics, viruses may evolve to resist the antiviral drug.</p>
| + | |
| − | <p><em>acyclovir</em> (Zovirax) - injectable solution, oral suspension, powder for injection, tablet, capsule, topical cream, topical ointment<br /><em>ganciclovir</em> (Cytovene) - capsule, powder for injection, oral solution, implant, ophthalmic gel<br /><em>valacyclovir</em> (Valtrex) - tablet</p>
| + | The cephalosporins are bactericidal antibiotics that have chemical structures similar to those of penicillins and therefor have the same mechanism of action. Also, due to their similar chemical structure to penicillin, there is a 7-10% potential of cross sensitivity. The cephalosporins are considered to be broad spectrum drugs. Their two main uses are as substitutes for penicillins in cases of allergy or bacterial resistance and in the treatment of certain gram negative infections. |
| − | <p><em>Quick review question 3<br /> </em></p>
| + | |
| − | <p>A patient receiving 100 mg of doxycycline every 12 hours should avoid taking their medication with which of the following items?</p>
| + | ''cefaclor'' (Ceclor) - capsule, tablet extended-release<br /> |
| − | <p> a. milk<br /> b. food<br /> c. Maalox (magnesium aluminum hydroxide)<br /> d. all of the above</p>
| + | ''cefazolin'' (Kefzol) - powder for injection<br /> |
| − | <p><em>Quick review question 4<br /> </em></p>
| + | ''cefdinir'' (Omnicef) - capsule, oral suspension<br /> |
| − | <p>If a patient has a penicillin allergy which of the following antibiotics should they avoid?</p>
| + | ''cefepime'' (Maxipime) - infusion solution, powder for injection<br /> |
| − | <p> a. Keflex<br /> b. Vancocin<br /> c. Septra<br /> d. Minocin</p>
| + | ''cefotaxime'' (Claforan) - injectable solution, powder for injection<br /> |
| − | <p><em>Quick review question 5<br /> </em></p>
| + | ''cefotetan'' (Cefotan) - injectable solution, powder for injection<br /> |
| − | <p>What is the generic name for Zosyn?</p>
| + | ''ceftaroline'' (Teflaro) - powder for injection<br /> |
| − | <p> a. amoxicillin & clavulanate<br /> b. ampicillin & sulbactam<br /> c. piperacillin & tazobactam<br /> d. ticarcillin & clavulanate</p>
| + | ''ceftazidime'' (Fortaz) - injectable solution, powder for injection<br /> |
| − | <p><em>Quick review question 6<br /></em></p>
| + | ''ceftriaxone'' (Rocephin) - injectable solution, powder for injection<br /> |
| − | <p>Zovirax (acyclovir) would me most accurately classified as which of the following?</p>
| + | ''cephalexin'' (Keflex) - capsule, film-coated tablet, oral suspension, tablet for oral suspension |
| − | <p> a. antibiotic<br /> b. amebicide<br /> c. antiviral<br /> d. viricide</p>
| + | |
| − | <p><em>Quick review question 7<br /></em></p>
| + | ====Aminoglycosides==== |
| − | <p>A prescription for sulfamethoxazole & trimethoprim should receive which of the following auxiliary labels?</p>
| + | |
| − | <p> a. Take medication on an EMPTY STOMACH<br /> b. Medication should be taken with plenty of WATER<br /> c. Do not take with dairy products, antacids, or iron preparations<br /> d. Take with FOOD</p>
| + | The aminoglycosides are a group of bactericidal antibiotics whose antibacterial spectrum mainly includes gram-negative bacilli. Aminoglycosides have poor oral absorption, therefore if systemic effects are desired they are usually given IV or IM. Aminoglycosides are both nephrotoxic (kidney) and ototoxic (ear). |
| − | <h3>Glucocorticosteroids</h3>
| + | |
| − | <p>Glucocorticosteriods (glucocorticoids) are steroids used to treat inflammation and various allergic conditions. They are similar to the steroid created in the adrenal cortex although they could be either from natural sources or synthetically manufactured. As your body naturally produces a glucocorticoid, introducing an exogenous source through medication interferes with your bodies negative feedback loop for production of these steroids. This is why it is often necessary to taper a patient off of a steroid so their body slowly start creating its own endogenous source of steroids again.</p>
| + | ''amikacin'' (Amikin) - injectable solution<br /> |
| − | <p>Long term use of glucocorticoids can have the following negative effects: thinning of skin, decrease wound healing, stunting pediatric growth, moon-face, obesity, and diabetes mellitus.</p>
| + | ''gentamicin'' (Garamycin) - injectable solution, ophthalmic ointment, ophthalmic suspension <br /> |
| − | <p><strong>Short-Acting Steroids</strong></p>
| + | ''kanamycin'' (Kantrex) - injectable solution<br /> |
| − | <p><em>hydrocortisone</em> (Cortef) - tablet, oral suspension, powder for injection, rectal cream, enema, foam, suppositories, topical cream, lotion, gel, topical solution, ointment, pledget</p>
| + | ''tobramycin'' (Nebcin, Tobi, Tobrex) - injectable solution, nebulizer solution, ophthalmic ointment, ophthalmic solution<br /> |
| − | <p><strong>Intermediate-Acting Steroids</strong></p>
| + | ''tobramycin & dexamethasone'' (TobraDex) - ophthalmic ointment, ophthalmic suspension - This is a combination of an aminoglycoside and a corticosteroid. |
| − | <p><em>fluticasone</em> (Flovent HFA, Flonase) - aerosol inhaler, disk inhaler, nasal spray, cream, ointment, lotion<br /><em>methylprednisolone</em> (Depo-Medrol, Medrol, Solu-Medrol) - tablet, injectable suspension, powder for injection, <br /><em>prednisolone</em> (Delta-Cortef) - oral solution, tablet, ophthalmic suspension, ophthalmic solution<br /><em>prednisone</em> (Deltasone) - oral solution, tablet <br /><em>triamcinolone</em> (Azmacort, Nasocort AQ, Kenalog) - nasal spray, inhalation aerosol, intravitreal injection, cream, ointment, paste, topical spray </p>
| + | |
| − | <p><strong>Long-Acting Steroids</strong></p>
| + | ====Tetracyclines==== |
| − | <p><em>dexamethasone</em> (Decadron) - tablet, injectable suspension, elixir, oral solution, oral concentrate, ointment, ophthalmic solution, ophthalmic suspension, intravitreal implant</p>
| + | |
| − | <p><em>Quick review question 8<br /></em></p>
| + | The tetracyclines (a group of broad-spectrum bacteriostatic antibiotics) are clinically useful in both gram-positive and gram-negative infections. |
| − | <p>Which of the following is a potential side effect of long-term use of glucocorticoids?</p>
| + | |
| − | <p> a. thinning of skin<br /> b. decreased wound healing<br /> c. moon-face<br /> d. all of the above</p>
| + | When ingested, it is usually recommended that tetracyclines should be taken with a full glass of water, either two hours after eating or one hour before eating. This is partly because tetracycline binds easily with magnesium, aluminum, iron, and calcium, which reduces its ability to be completely absorbed by the body. Dairy products or preparations containing iron are not recommended directly after taking the drug. |
| − | <h3>Drugs affecting the sympathetic nervous system</h3>
| + | |
| − | <p>The sympathetic nervous system is part of the autonomic nervous system that tends to act in opposition to the parasympathetic nervous system, by speeding up the heartbeat and causing contraction of the blood vessels. It regulates the function of the sweat glands and stimulates the secretion of glucose in the liver. The sympathetic nervous system is usually activated under conditions of stress cause the 'fight or flight' response.</p>
| + | Side effects from tetracyclines are not always common, but of particular note is possible photosensitive allergic reaction which increases the risk of sunburn under exposure to UV light from the sun or other sources. Tetracyclines are teratogens due to the likelihood of causing teeth discoloration in the fetus as they develop in infancy. For this same reason, tetracyclines are contraindicated for use in children under 12 years of age. |
| − | <p>The sympathetic nervous system can be excited or inhibited through either stimulating or inhibiting adrenergic receptors. These adrenergic receptors are normally stimulated by endogenous norepinephrine, but they can be stimulated by exogenous chemicals of either natural or synthetic origin. These adrenergic receptors can be further broken up into subgroups called alpha-1, alpha-2, beta-1, and beta-2 adrenergic receptors. Excitation of alpha-1 and alpha-2 adrenergic receptors causes contraction of smooth muscle resulting in vasoconstriction of most blood vessels, contraction of sphincter muscles in the GI and urinary tract, and dilation of the pupil of the eye (mydriasis). Stimulation of beta-1 adrenergic receptors cause stimulation of the heart (increased heart rate and force of contraction). Stimulation of beta-2 adrenergic receptors cause bronchodilation. Inhibition (blocking) of these receptors cause the opposite effect to occur.</p>
| + | |
| − | <p>Let's look at drugs that affect these various receptors.</p>
| + | ''doxycycline'' (Vibramycin) - capsule, powder for injection, syrup, tablet, delayed-release tablet<br /> |
| − | <p><strong>Adrenergic Agonists</strong></p>
| + | ''minocycline'' (Minocin) - oral suspension, tablet, capsule, extended-release tablet, intravenous injection<br /> |
| − | <p>These drugs stimulate all the adrenergic receptors to varying degrees and will therefore have the effects related to stimulation of these receptors. This allows these drugs to be used for a multitude of purposes such as acute hypotension (ephedrine, NE, PE), cardiac arrest (EPI, NE), severe asthma (EPI), bronchodilation (ephedrine), anaphylaxis (EPI), congestion (PE), and can be used to dilate pupils (PE).</p>
| + | ''tetracycline'' (Sumycin) - capsule, tablet<br /> |
| − | <p><em>ephedrine</em> - injectable solution<br /><em>epinephrine, EPI</em> (EpiPen, Racepinephrine) - autoinjector, injectable solution, solution for nebulization<br /><em>norepinephrine, NE</em> (Levophed) - injectable solution<br /><em>pseudoephedrine, PE</em> (Sudafed) - tablet, syrup</p>
| + | ''tigecycline'' (Tygacil) - powder for injection |
| − | <p><strong>Alpha-2 Adrenergic Agonists</strong></p>
| + | |
| − | <p>Alpha-2 agonists, despite stimulating the alpha-2 adrenergic receptors actually function against the sympathetic nervous system and sometimes will be classified as sympathetic blocking (sympatholytic) drugs. The net result is a decrease in cardiac output and vasodilation making them useful in the treatment of hypertension.</p>
| + | ====Sulfonamides==== |
| − | <p><em>clonidine</em> (Catapres, Catapres TTS) - injectable solution, extended-release oral suspension, patch, tablet, extended-release tablet<br /><em>guanfacine</em> (Tenex) - tablet</p>
| + | |
| − | <p><strong>Alpha-Adrenergic Blocking Agents</strong></p>
| + | Sulfonamides are a group of synthetic bacteriostatic drugs which are effective against both gram-positive and gram-negative infections. Approximately 3% of people using sulfonamides report side effects, the most common of which are hypersensitivity reactions such as rash and hives, but some patients may have more severe reactions. |
| − | <p>Alpha-adrenergic blocking drugs are primarily used to treat benign prostatic hypertrophy (BPH). These medications also cause vasodilation and reduced blood pressure, making them suitable choices for treating hypertension.</p>
| + | |
| − | <p><em>doxazosin</em> (Cardura, Cardura XL) - tablet, extended-release tablet<br /><em>tamsulosin</em> (Flomax) - capsule<br /><em>terazosin</em> (Hytrin) - capsule</p>
| + | Sulfonamides have the potential to crystallize in the kidneys, due to their low solubility. This is a very painful experience, so patients are recommended to take these medication with large amounts of water. |
| − | <p><strong>Beta-Adrenergic Blocking Agents</strong></p>
| + | |
| − | <p>By blocking the beta-adrenergic receptors you can decrease the heart rate and the force of contractions causing a decrease in blood pressure. This means the drugs can treat hypertension, angina pectoris, tachycardia, and arrhythmias.</p>
| + | ''silver sulfidiazine'' (Silvadene) - cream<br /> |
| − | <p><em>atenolol</em> (Tenormin) - Tablet<br /><em>bisoprolol</em> (Zebeta) - Tablet<br /><em>carvedilol</em> (Coreg, Coreg CR) - extended-release capsule, tablet<br /><em>labetalol</em> (Trandate) - injectable solution, tablet <br /><em>metoprolol</em> (Lopressor, Toprol XL) - injectable solution, tablet, extended-release tablet <br /><em>nebivolol</em> (Bystolic) - tablet<br /><em>propranolol</em> (Inderal, Inderal LA) - oral solution, injectable solution, tablet, extended-release capsule<br /><em>timolol</em> (Timol, Timoptic, Timoptic XE) - ophthalmic solution, gel forming ophthalmic solution</p>
| + | ''sulfamethoxazole & trimethoprim, SMZ & TMP'' (Bactrim, Septra, Co-Trimoxazole) - injected solution, oral solution, tablet<br /> |
| − | <p><em>Quick review question 9<br /></em></p>
| + | ''sulfasalazine (Azulfidine)'' - tablet, extended-release tablet |
| − | <p>If a patient were having a severe asthma attack which medication might an emergency department administer?</p>
| + | |
| − | <p> a. norepinephrine<br /> b. epinephrine<br /> c. labetalol<br /> d. doxazosin</p>
| + | ====Macrolide Antibiotics==== |
| − | <p><em>Quick review question 10<br /></em></p>
| + | |
| − | <p>Which of the following drugs are considered a beta-blocker?</p>
| + | The term macrolide refers to the large chemical ring structure that is characteristic of these antibiotics. These antibiotics inhibit bacterial protein synthesis and can be bacteriostatic or bactericidal. Food effects oral absorption of these drugs, although they frequently cause GI problems which may warrant taking them with food. Macrolides may interfere with some medications that require liver biotransformation such as digoxin, warfarin, and cyclosporine therefore a different antibiotic choice may be desirable if a patient is currently using any of those medications. |
| − | <p> a. Toprol XL<br /> b. Tenex<br /> c. Hytrin<br /> d. Levophed</p>
| + | |
| − | <h3>Drugs affecting the parasympathetic nervous system</h3>
| + | ''azithromycin'' (Zithromax, AzaSite) - oral suspension, powder for injection, powder for oral suspension, extended-release powder for oral suspension, tablet, ophthalmic solution<br /> |
| − | <p>The parasympathetic nervous system is part of the autonomic nervous system that tends to act in opposition to the sympathetic nervous system, by primarily regulating body functions during rest, digestion, and waste regulation. Stimulation of the parasympathetic system increases the activity of the gastrointestinal and genitourinary system while decreasing the activity of the cardiovascular system.</p>
| + | ''clarithromycin'' (Biaxin) - oral suspension, tablet, extended-release tablet<br /> |
| − | <p><strong>Cholinergic Drugs</strong></p>
| + | ''erythromycin'' (Erythrocin, E-Mycin) - tablet, delayed-release tablet, dispertab, injection, oral suspension, ophthalmic ointment |
| − | <p>The parasympathetic system is regulated by cholinergic receptors. The naturally occurring chemical that stimulates these receptors is called acetylcholine (ACH). Drugs that mimic ACH are therefor called cholinergic drugs. The conditions treated by this class of drugs varies widely. Donepezil and galantamine are each primarily used to treat Alzheimer's disease, while neostigmine is used to treat myasthenia gravis, and is an antidote for nondepolarizing neuromuscular blocking drugs (a group of drugs often used to create a neuromuscular blockade during surgery).</p>
| + | |
| − | <p><em>donepezil</em> (Aricept, Aricept ODT) - tablet, orally disintegrating tablet<br /><em>galantamine</em> (Reminyl) - tablet, extended-release tablet, oral solution<br /><em>neostigmine</em> (Prostigmin) - injectable solution, tablet</p>
| + | ====Fluoroquinolones==== |
| − | <p><strong>Anticholinergic Drugs</strong></p>
| + | |
| − | <p>A naturally occurring chemical that works opposite of ACH is acetylcholinesterase, and therefor drugs that mimic acetylcholinesterase are often referred to as anticholinergic drugs. The conditions treated by this group of drugs also varies widely. Atropine can be used to increase the heart rate, anesthesia premedication, reversal of cholinergic drugs, treatment of GI spasticity, mydriasis, and enuresis treatment. Dicyclomine is typically used to treat GI disorders such as ulcers and colitis. Oxybutynin and tolterodine are typically used in the treatment of overactive bladder.</p>
| + | The fluoroquinolones, often just called quinolone antibiotics, are synthetic antimicrobial agents that are a broad spectrum bactericidal, especially against gram-negative organisms. A black box warning has been added to all fluoroquinolones involving an increased risk of developing tendinitis and tendon rupture in patients of all ages taking fluoroquinolones for systemic use. This risk is further increased in individuals over 60 years of age, taking corticosteroid drugs, and have received kidney, heart, or lung transplants. |
| − | <p><em>atropine</em> (AtroPen, IsoptoAtropine) - injectable solution, tablet, ophthalmic solution, ophthalmic ointment<br /><em>dicyclomine</em> (Bentyl) - capsule, injectable solution, syrup, tablet<br /><em>oxybutynin</em> (Ditropan, Ditropan XL) - tablet, controlled-release tablet, syrup, transdermal patch, gel<br /><em>tolterodine</em> (Detrol, Detrol LA) -tablet, extended-release capsule</p>
| + | |
| − | <p><em>Quick review question 11<br /></em></p>
| + | ''ciprofloxacin'' (Cipro) - infusion solution, oral suspension, tablet, extended-release tablet, ophthalmic solution, ophthalmic ointment, otic solution<br /> |
| − | <p>A patient, after surgery, is mostly likely to receive what medication to reverse the affects of vecuronium?</p>
| + | ''levofloxacin'' (Levaquin) - injectable solution, premix infusion solution, oral solution, tablet, ophthalmic solution<br /> |
| − | <p> a. neostigmine<br /> b. tolterodine<br /> c. atropine<br /> d. galantamine</p>
| + | ''moxifloxacin'' (Avelox) - injectable solution, tablet, opthalmic solution<br /> |
| − | <h3>Skeletal muscle relaxants</h3>
| + | ''ofloxacin'' (Floxin) - tablet, ophthalmic solution, otic solution |
| − | <p>Skeletal muscle relaxants are used to treat conditions such as muscle spasticity and to relax muscle tone during surgeries. Medication that block muscle contraction within the spinal cord are referred to as centrally acting skeletal muscle relaxants, conversely peripherally acting skeletal muscle relaxants inhibit muscle contraction at the neuromuscular junction (NMJ).</p>
| + | |
| − | <p>All patients using skeletal muscle relaxants should avoid additional items that will depress the CNS or impair neuromuscular function such as alcohol, sedatives, and tranquilizers. There is also concern over abuse of these drugs, whether on their own or being used with other medications. Hence, carisoprodol was recently made a schedule IV controlled substance.</p>
| + | ====Miscellaneous Antibiotics==== |
| − | <p><strong>Peripherally Acting Skeletal Muscle Relaxants</strong></p>
| + | |
| − | <p>Peripherally acting skeletal muscle relaxants are primarily used to prevent muscle contractions during surgeries or procedures where reflexes need to be suppressed (i.e., intubation). They can further be broken into two major subgroups depolarizing (succinylcholine) and nondepolarizing (cisatracurium, pancuronium, rocuronium, and vecuronium).</p>
| + | Some common antibiotics are the only drugs in their respective classes. The following listed medications are examples of those. These drugs each have their own side effects and precautions, for example, IV use of vancomycin may cause a reaction known as red man syndrome characterized by flushing and/or rash that affects the face, neck, and upper torso. |
| − | <p><em>cisatracurium</em> (Nimbex) - injectable solution<br /><em>pancuronium</em> (Pavulon) - injectable solution<br /><em>rocuronium</em> (Zemuron) - injectable solution<br /><em>succinylcholine, SUX</em> (Anectine) - injectable solution<br /><em>vecuronium</em> (Norcuron) - powder for injection</p>
| + | |
| − | <p><strong>Centrally Acting Skeletal Muscle Relaxants</strong></p>
| + | ''aztreonam'' (Azactam) - infusion solution, powder for injection<br /> |
| − | <p>Centrally acting skeletal muscle relaxants are primarily used to treat muscle spasms that may be caused by overexertion, trauma, or nervous tension. Baclofen and tizanidine are also used to treat multiple sclerosis.</p>
| + | ''clindamycin'' (Cleocin) - capsule, injectable solution, oral solution, vaginal cream, vaginal suppository<br /> |
| − | <p><em>baclofen</em> (Lioresal) - tablet, injectable solution<br /><em>carisoprodol</em> (Soma) CIV - tablet<br /><em>cyclobenzaprine</em> (Flexeril) - tablet, extended-release capsule<br /><em>metaxalone</em> (Skelaxin) - tablet<br /><em>methocarbamol</em> (Robaxin) - tablet, injectable solution<br /><em>tizanidine</em> (Zanaflex) - tablet, capsule</p>
| + | ''daptomycin'' (Cubicin) - injectable solution<br /> |
| − | <p><em>Quick review question 12<br /></em></p>
| + | ''linezolid'' (Zyvox) - injectable solution, oral suspension, tablet<br /> |
| − | <p>A patient taking Flexeril due to spasms related to a traumatic back injury should avoid avoid what?</p>
| + | ''mupirocin'' (Bactroban) - cream, topical ointment, nasal ointment<br /> |
| − | <p> a. alcohol<br /> b. sedatives<br /> c. tranquilizers<br /> d. all of the above</p>
| + | ''nitrofurantoin'' (Macrobid) - capsule, oral suspension<br /> |
| − | <h3>Local Anesthetics</h3>
| + | ''vancomycin'' (Vancocin) - capsule, injectable solution, powder for injection |
| − | <p>Local anesthetics, as their name implies, causes a temporary loss of feeling in a confined area of the body. Local anesthetics can be broken into two major groups, amide local anesthetics and ester local anesthetics. Cocaine is also used as a local anesthetic because despite its abuse potential, it is the only local anesthetic that causes vasoconstriction.</p>
| + | |
| − | <p><strong>Ester Local Anesthetics</strong></p>
| + | ====Antifungals==== |
| − | <p>In general ester local anesthetics have a short or moderate duration of action.</p>
| + | |
| − | <p><em>benzocaine</em> (Solarcaine) - gel, topical solution, otic solution <br /><em>cocaine</em> CII - topical solution<br /><em>tetracaine</em> (Pontocaine) - injectable solution, powder for injection, throat spray, ophthalmic solution</p>
| + | An antifungal drug is medication used to treat fungal infections such as athlete's foot, ringworm, candidiasis (thrush), serious systemic infections such as cryptococcal meningitis, and others. |
| − | <p><strong>Amide Local Anesthetics</strong></p>
| + | |
| − | <p>Typically, amide local anesthetics have a long duration of action.</p>
| + | Antifungals work by exploiting differences between mammalian and fungal cells to kill off the fungal organism without dangerous effects on the host. Unlike bacteria, both fungi and humans are eukaryotes. Thus fungal and human cells are similar at the molecular level. This means it is more difficult to find a target for an antifungal drug to attack that does not also exist in the infected organism. Consequently, there are often side-effects to some of these drugs. Many of these agents are hepatotoxic (liver) and liver function and enzymes must be monitored. It is not uncommon for therapy to last for several months. |
| − | <p><em>bupivacaine</em> (Marcaine, Sensorcaine) - injectable solution<br /><em>lidocaine</em> (Xylocaine, Lidoderm) - injectable solution, infusion solution, oral solution, topical ointment, topical solution, topical jelly, patch</p>
| + | |
| − | <p><em>Quick review question 13<br /></em></p>
| + | ''amphotericin B'' (Fungizone) - powder for injection, injectable lipid complex, cream, lotion, ointment<br /> |
| − | <p>Which local anesthetic causes vasoconstriction?</p>
| + | ''betamethasone & clotrimazole'' (Lotrisone) - cream, lotion - This is a combination of a corticosteroid and an antifungal.<br /> |
| − | <p> a. benzocaine<br /> b. cocaine<br /> c. bupivacaine<br /> d. lidocaine</p>
| + | ''clotrimazole'' (Gyne-Lotrimin, Mycelex) - troche, vaginal cream, vaginal tablet, cream, topical solution, lotion, powder<br /> |
| − | <h3>Medications for treating psychological conditions</h3>
| + | ''fluconazole'' (Diflucan) - injected solution, oral suspension, tablet |
| − | <p><strong>Antipsychotic Drugs</strong></p>
| + | ''nystatin'' (Mycostatin, Nilstat) - oral powder, oral suspension, oral tablet, troche, cream, ointment, powder, vaginal tablet<br /> |
| − | <p>Antipsychotic drugs, referred to as neuroleptics, are used to suppress the symptoms of schizophrenia and other psychotic conditions. Antipsychotics are associated with a range of side effects. Approximately two-thirds of patients will discontinue use due in part to adverse effects. Side effects may include acute dystonias, akathisia, parkinsonism, tardive dyskinesia, tachycardia, hypotension, impotence, lethargy, seizures, intense dreams or nightmares, and hyperprolactinaemia. Side effects from antipsychotics can be managed by a number of different drugs. For example, anticholinergics are often used to alleviate the motor side effects of antipsychotics. Some of the side-effects will appear after the drug has been used only for a long time. When discontinuing therapy, patients must be tapered off of these drugs.</p>
| + | ''terbinafine'' (Lamisil) - tablet, oral granules, cream, topical solution |
| − | <p><em>clozapine</em> (Clozaril) - tablet, orally disintegrating tablet<br /><em>haloperidol</em> (Haldol) - tablet, oral concentrate, injectable solution, injectable solution-decanoate<br /><em>olanzapine</em> (Zyprexa, Zyprexa Zydis) - tablet, orally disintegrating tablet, short-acting IM injection, extended-release suspension IM injection<br /><em>quetiapine</em> (Seroquel, Seroquel XR) - tablet, extended-release tablet<br /><em>risperidone</em> (Risperdal, Risperdal Consta) - tablet, orally-disintegrating tablet, oral solution, powder for injection <br /><em>ziprasidone</em> (Geodon) - capsule, powder for injection</p>
| + | |
| − | <p><strong>Hypnotics</strong></p>
| + | ====Amebicides==== |
| − | <p>Hypnotics are primarily used to induce and maintain sleep, usually to treat insomnia. There are three major categories of hypnotics benzodiazepines, barbiturates, and nonbarbiturates. Other medications and substances that cause CNS depression (such as alcohol) should be avoided.</p>
| + | |
| − | <p><em>Benzodiazepines</em></p>
| + | An amebicide (or amoebicide) is an agent used in the treatment of amoebic infections. Alcohol use should be avoided while taking metronidazole because concurrent use may cause nausea, vomiting, flushing of the skin, tachycardia, and shortness of breath. |
| − | <p>Benzodiazepines are commonly used as anxiolytics, sedatives, hypnotics, anticonvulsants, and skeletal muscle relaxants.</p>
| + | |
| − | <p><em>alprazolam</em> (Xanax) CIV - tablet, extended-release tablet, orally-disintegrating tablet, oral solution<br /><em>clonazepam</em> (Klonopin) CIV - tablet<br /><em>diazepam</em> (Valium) CIV - tablet, oral solution, rectal solution, injectable solution, intramuscular device<br /><em>lorazepam</em> (Ativan) CIV - tablet, oral concentrate, injectable solution<br /><em>temazepam</em> (Restoril) CIV - tablet</p>
| + | ''metronidazole'' (Flagyl) - capsule, tablet, extended-release tablet, infusion solution, topical gel, topical cream, topical lotion, vaginal gel<br /> |
| − | <p><em>Barbiturates</em></p>
| + | ''pentamidine'' (Pentam) - powder for injection, powder for nebulizer solution |
| − | <p>Barbiturates are drugs that act as central nervous system depressants, and can therefore produce a wide spectrum of effects, from mild sedation to total anesthesia. They are also effective as anxiolytics, as hypnotics, and as anticonvulsants. Barbiturates also have analgesic effects, however these effects are somewhat weak, preventing barbiturates from being used in surgery in the absence of other analgesics.</p>
| + | |
| − | <p><em>phenobarbital</em> (Luminal) CIV - tablet, elixir, injectable solution</p>
| + | ====Antimalarial Drugs==== |
| − | <p><em>Nonbarbiturate Hypnotics</em></p>
| + | |
| − | <p>Barbiturates, while strictly considered hypnotics, have been largely replaced by the newer nonbarbiturates for treating insomnia since barbiturates are know to cause a 'hangover' effect.</p>
| + | Antimalarial drugs are agents used to prevent and cure malaria. Some antimalarial drugs, such as hydroxychloroquine, are also used to treat conditions like rheumatoid arthritis and lupus. One of the most serious side effects is a toxicity in the eye (this primarily occurs with chronic use). |
| − | <p><em>eszopiclone</em> (Lunesta) CIV - tablet<br /><em>ramelteon</em> (Rozerem) - tablet<br /><em>zaleplon</em> (Sonata) CIV - capsule<br /><em>zolpidem</em> (Ambien, Ambien CR) CIV - tablet, extended-release tablet, sublingual tablet, oral spray</p>
| + | |
| − | <p><strong>Antidepressants</strong></p>
| + | ''hydroxychloroquine'' (Plaquenil) - tablet<br /> |
| − | <p>An antidepressant is a psychiatric medication used to alleviate mood disorders, such as major depression and dysthymia and anxiety disorders such as social anxiety disorder. </p>
| + | ''quinine sulfate'' (Qualaquin) - capsule |
| − | <p>Antidepressants carry a black box warning that in short-term studies, antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults.</p>
| + | |
| − | <p><em>Tricyclic Antidepressants</em></p>
| + | ====Antivirals==== |
| − | <p>The tricyclic antidepressants are used primarily in the clinical treatment of mood disorders such as major depressive disorder, dysthymia, and treatment-resistant variants. They are also used in the treatment of a number of other medical disorders, including anxiety disorders such as generalized anxiety disorder, social phobia also known as social anxiety disorder, obsessive-compulsive disorder, and panic disorder, post-traumatic stress disorder, body dysmorphic disorder, eating disorders like anorexia nervosa and bulimia nervosa, certain personality disorders such as borderline personality disorder, attention-deficit hyperactivity disorder, as well as chronic pain, neuralgia or neuropathic pain, and fibromyalgia, headache, or migraine, smoking cessation, tourette syndrome, trichotillomania, irritable bowel syndrome, interstitial cystitis, nocturnal enuresis, narcolepsy, insomnia, pathological crying and/or laughing, chronic hiccups, ciguatera poisoning, and as an adjunct in schizophrenia.</p>
| + | |
| − | <p><em>amitriptyline</em> (Elavil) - tablet<br /><em>doxepin</em> (Sinequan) - capsule, tablet, oral concentrate</p>
| + | Antiviral drugs are a class of medication used specifically for treating viral infections. Like antibiotics, specific antivirals are used for specific viruses. They are relatively harmless to the host, and therefore can be used to treat infections. They should be distinguished from viricides, which actively deactivate virus particles outside the body. |
| − | <p><em>Selective Serotonin Reuptake Inhibitors</em></p>
| + | |
| − | <p>Selective Serotonin Reuptake Inhibitors (SSRIs) are believed to work by decreasing the central nervous system's neuronal uptake of serotonin (5-HT). While these drugs can be used for a very broad range of things, you will typically see them used for treating moderate to major depression, generalized anxiety disorder, panic disorders, social anxiety, post-traumatic stress disorder, premenstrual dysphoric disorder, and prevention of migraine.</p>
| + | Most of the antivirals now available are designed to help deal with HIV; herpes viruses, best known for causing cold sores and genital herpes, but actually causing a wide range of diseases; the hepatitis B and C viruses, which can cause liver cancer; and influenza A and B viruses. Researchers are now working to extend the range of antivirals to other families of pathogens. |
| − | <p><em>citalopram</em> (Celexa) - tablet, oral solution<br /><em>escitalopram</em> (Lexapro) - tablet, oral solution<br /><em>fluoxetine</em> (Prozac) - tablet, capsule, delayed-release capsule, oral solution<br /><em>fluvoxamine</em> (Luvox) - tablet, extended-release capsule<br /><em>paroxetine</em> (Paxil) - tablet, extended-release tablet, oral suspension</p>
| + | |
| − | <p><em>Serotonin-Noerpinephrine Reuptake Inhibitors</em></p>
| + | Antiviral drugs work by inhibiting the virus ether before it enters the cell, stopping it from reproducing, or in some cases preventing it from exiting the cell. However, like antibiotics, viruses may evolve to resist the antiviral drug. |
| − | <p>Serotonin-norepinephrine reuptake inhibitors (SNRIs) prevent the uptake of neuronal serotonin and norepinephrine and are a less potent inhibitor of dopamine reuptake. The increase in these chemicals is believed to be related to their use in treating depression and anxiety. Duloxetine is also commonly used to treat chronic musculoskeletal pain, diabetic peripheral neuropathic pain, and fibromyalgia.</p>
| + | |
| − | <p><em>desvenlafaxine</em> (Pristiq) - extended-release tablet<br /><em>duloxetine</em> (Cymbalta) - capsule<br /><em>venlafaxine</em> (Effexor, Effexor XR) - tablet, extended-release tablet, extended-release capsule</p>
| + | ''acyclovir'' (Zovirax) - injectable solution, oral suspension, powder for injection, tablet, capsule, topical cream, topical ointment<br /> |
| − | <p><em>Miscellaneous Antidepressants</em></p>
| + | ''ganciclovir'' (Cytovene) - capsule, powder for injection, oral solution, implant, ophthalmic gel<br /> |
| − | <p>The medications in this category have varied mechanisms of action, but all function as antidepressants. Bupropion is also used for seasonal affective disorder, and smoking cessation. Mirtazapine is also used for post-traumatic stress disorder (PTSD). Trazadone is used for a number of things including aggressive behavior, alcohol withdrawal, insomnia, and prevention of migraine.</p>
| + | ''valacyclovir'' (Valtrex) - tablet |
| − | <p><em>bupropion</em> (Wellbutrin, Zyban) - tablet, sustained-release tablet, extended-release tablet<br /><em>mirtazapine</em> (Remeron, Remeron SolTab) - tablet, orally-disintegrating tablet<br /><em>trazadone</em> (Desyrel, Desyrel Dividose) - tablet, extended-release tablet</p>
| + | |
| − | <p><strong>Antianxiety Agent, Nonbenzodiazepine</strong></p>
| + | |
| − | <p>While many anxiolytic agents are related to benzodiazepines, one popular alternative is buspirone. It has a high affinity for 5HT1 receptors and a moderate affinity for dopamine D2 receptors. Buspirone is considered to have very little abuse potential; so unlike benzodiazepines, it is not a controlled substance.</p>
| + | |
| − | <p><em>buspirone</em> (BusPar) - tablet</p>
| + | |
| − | <p><strong>Partial Nicotinic Receptor Antagonist</strong></p>
| + | |
| − | <p>Varenicline is used as a smoking cessation aid without actually using any form of nicotine. There is a heightened caution with this drug about suicidal ideation (suicidal thoughts).</p>
| + | |
| − | <p><em>varenicline</em> (Chantix) - tablet</p>
| + | |
| − | <p><strong>Amphetamines</strong></p>
| + | |
| − | <p>Amphetamines are commonly used to treat attention deficit hyperactivity disorder (ADHD) and narcolepsy. Their ability to improve focus/concentration and boost energy levels has made this class of drugs very desirable for abuse, therefore all amphetamines are considered schedule II controlled substances. Side effects may consist of severe weight loss, also dependence may develop during use of this drug. Amphetamines can also raise the heart rate to dangerous levels.</p>
| + | |
| − | <p><em>amphetamine & dextroamphetamine</em> (Adderall, Adderall XR) CII - tablet, capsule, extended-release capsule <br /><em>dexmethylphenidate</em> (Focalin, Focalin XR) CII - tablet, extended-release capsule <br /><em>lisdexamfetamine</em> (Vyvanse) CII - capsule<br /><em>methylphenidate</em> (Ritalin, Concerta, Daytrana) CII - tablet, chewable tablet, extended-release tablet, capsule, extended-release capsule, oral solution, transdermal patch</p>
| + | |
| − | <p><strong>Anorexiant</strong></p>
| + | |
| − | <p>Phentermine is indicated as a short-term (a few weeks) adjunct therapy for weight reduction based on increased exercise, behavior modification, and calorie reduction.</p>
| + | |
| − | <p><em>phentermine</em> (Adipex P) CIV - tablet, orally-disintegrating tablet, capsule</p>
| + | |
| − | <p><strong>Stimulant</strong></p>
| + | |
| − | <p>Modafinil may increase dopamine in the brain by decreasing dopamine reuptake. Modafinil is used for treating narcolepsy, shift work sleep disorder, treating Obstructive Sleep Apnea/Hypopnea Syndrome (OSAHS), and off label it is used fatigue in MS patients and for depression.</p>
| + | |
| − | <p><em>modafinil</em> (Provigil) CIV - tablet</p>
| + | |
| − | <p><strong>Antimanic Drug</strong></p>
| + | |
| − | <p>Lithium is one of the oldest medications on the market for treating mania and is still quite popular. Lithium is also sometimes used to treat Huntington's disease, neutropenia (due to chemotherapy, or AIDS), cluster headache, PMS, bulimia, alcoholism, syndrome of inappropriate antidiuretic hormone secretion (SIADH), tardive dyskinesia, hyperthyroidism, and psychosis (postpartum or steroid-induced).</p>
| + | |
| − | <p>Lithium works by altering cation transport in nerve and muscle cells, and influences serotonin and/or norepinephrine reuptake.</p>
| + | |
| − | <p>Many of the antiepileptic drugs discussed later in this chapter are also often used as mood-stabilizing drugs.</p>
| + | |
| − | <p><em>lithium</em> (Eskalith, Lithobid) - tablet, extended-release tablet, capsule, syrup</p>
| + | |
| − | <p><strong>NMDA Antagonist</strong></p>
| + | |
| − | <p>N-methyl-D-aspartate (NMDA) antagonists prevent excessive stimulation of the NMDA-receptor, which is ordinarily stimulated by glutamate. At normal levels, glutamate aids in memory and learning, but if levels are too high, glutamate appears to overstimulate nerve cells, killing them through excitotoxicity.</p>
| + | |
| − | <p>Memantine has been associated with a moderate decrease in clinical deterioration with only a small positive effect on cognition, mood, behavior, and the ability to perform daily activities in moderate to severe Alzheimer's disease. There does not appear to be any benefit in mild disease.</p>
| + | |
| − | <p><em>memantine</em> (Namenda) - tablet, extended-release capsule, oral solution</p>
| + | |
| − | <p><strong>Other Psychiatry Agents</strong></p>
| + | |
| − | <p>Atomoxetine is used to treat ADHD. It functions as a selective inhibitor of presynaptic norepinephrine transport. Unlike amphetamines used to treat ADHD, atomoxetine is considered to have little or no abuse potential.</p>
| + | |
| − | <p><em>atomoxetine</em> (Strattera) - capsule</p>
| + | |
| − | <p><em>Quick review question 14<br /></em></p>
| + | |
| − | <p>Antidepressants carry a black box warning that in short-term studies:</p>
| + | |
| − | <p> a. they may significantly reduce a patient's libido.<br /> b. these medications have been associated with nausea, vomiting, and diarrhea.<br /> c. antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults.<br /> d. none of the above</p>
| + | |
| − | <p><em>Quick review question 15<br /></em></p>
| + | |
| − | <p>All of the following classifications of drugs are frequently used as antidepressants except:</p>
| + | |
| − | <p> a. selective serotonin reuptake inhibitors<br /> b. serotonin-norepinephrine reuptake inhibitors<br /> c. tricyclic antidepressants<br /> d. benzodiazepines</p>
| + | |
| − | <p><em>Quick review question 16<br /></em></p>
| + | |
| − | <p>Which of the following drugs might be used for treating schizophrenia?</p>
| + | |
| − | <p> a. olanzapine<br /> b. clonazepam<br /> c. zaleplon<br /> d. varenicline</p>
| + | |
| − | <p><em>Quick review question 17<br /></em></p>
| + | |
| − | <p>Which of the following hypnotics is a schedule IV controlled substance?</p>
| + | |
| − | <p> a. Xanax<br /> b. Luminal<br /> c. Ambien<br /> d. all of the above</p>
| + | |
| − | <h3>Antiepileptic drugs</h3>
| + | |
| − | <p>Antiepileptic drugs (AEDs) will also sometimes be referred to as anticonvulsants. All of the drugs in this category can be used for treating various types of seizures and many of these medications have additional uses such as treating trigeminal neuralgia (carbamazepine), bipolar disorder (carbamazepine, lamotrigine, valproic acid), postherpetic neuralgia (gabapentin, pregabalin), muscle cramps (gabapentin), anxiety (gabapentin), diabetic neuropathy (gabapentin, pregabalin), fibromyalgia (pregabalin), neuropathic pain with spinal cord injury (pregabalin), migraine prophylaxis (topiramate, valproic acid), cluster-headache prophylaxis (topiramate), and alcoholism (topiramate).</p>
| + | |
| − | <p><em>carbamazepine</em> (Tegretol, Equetro) - tablet, extended-release tablet, extended-release capsule, oral suspension<br /><em>gabapentin</em> (Neurontin) - capsule, tablet, oral solution<br /><em>lamotrigine</em> (Lamictal) - tablet, chewable tablet, orally-disintegrating tablet, extended-release tablet<br /><em>levetiracetam</em> (Keppra) - tablet, extended-release tablet, oral solution, injectable solution<br /><em>oxcarbazepine</em> (Trileptal) - tablet, extended-release tablet, oral suspension <br /><em>pregabalin</em> (Lyrica) CV - capsule, oral solution<br /><em>topiramate</em> (Topamax) - tablet, capsule<br /><em>valproic acid</em> (Depakote, Depakene, Depacon) - tablet, delayed-release tablet, extended-release tablet, capsule, delayed-release capsule, sprinkle capsule, syrup, injectable solution</p>
| + | |
| − | <p><em>Quick review question 18<br /></em></p>
| + | |
| − | <p>Which of the following drugs may be used for treating seizures?</p>
| + | |
| − | <p> a. carbamazepine<br /> b. gabapentin<br /> c. topiramate<br /> d. all of the above</p>
| + | |
| − | <h3>Antiparkinson drugs</h3>
| + | |
| − | <p>Parkinson disease is a common neurologic disorder affecting approximately 1% of the population over the age of 60 (a much smaller percentage of the population will sometimes have this disease at an earlier age) caused by the loss of dopamine receptors. This disease presents a number of motor and nonmotor symptoms related to the loss of dopamine receptors.</p>
| + | |
| − | <p>Typically, the first motor symptom is a resting tremor in an upper extremity. Over time, additional motor symptoms occur including bradykinesia, rigidity, and gait difficulty. The first affected arm may not swing fully when walking, and the foot on the same side may scrape the floor. As the disease progresses posture becomes increasingly flexed and strides become shorter causing a shuffling motion from the patient.</p>
| + | |
| − | <p>Nonmotor symptoms usually begin with the loss of smell, and is followed by rapid eye movements and behavior disorders.</p>
| + | |
| − | <p>The most common treatment is the use of carbidopa & levodopa to provide dopamine replacement therapy. Dopamine agonists, such as ropinirole, are also useful in decreasing the symptoms.</p>
| + | |
| − | <p><em>carbidopa & levodopa</em> (Sinemet, Sinemet CR, Parcopa) - tablet, orally-disintegrating tablet, extended-release tablet<br /><em>ropinirole</em> (Requip, Requip XL) - tablet, extended-release tablet</p>
| + | |
| − | <p><em>Quick review question 19<br /></em></p>
| + | |
| − | <p>Parkinson disease is associated with the loss of which receptors?</p>
| + | |
| − | <p> a. alpha<br /> b. beta<br /> c. dopamine<br /> d. acetylcholine</p>
| + | |
| − | <h3>Analgesics</h3>
| + | |
| − | <p><strong>Opioid Analgesics</strong></p>
| + | |
| − | <p>Opioid analgesics are often used to treat acute pain (such as post-operative pain), and for palliative care to alleviate the severe, chronic, disabling pain of terminal conditions such as cancer, and sometimes for degenerative conditions such as rheumatoid arthritis. There has been an increased use of opioids in the management of non-malignant chronic pain. Opioids also have antitussive and antidiarrheal effects, therefore low doses and or weaker forms of these medications will sometimes be used for those purposes as well. These medications do have a potential for abuse due to their addictive nature. While addictive themselves, two of these medications (buprenorphine & naloxine and methadone) can be used to treat opioid addiction. Most of these medications are considered controlled substances and their federal schedules are listed beside them.</p>
| + | |
| − | <p><em>buprenorphine & naloxone</em> (Suboxone) CIII - sublingual tablet, sublingual film<br /><em>codeine</em> CII - tablet, oral solution<br /><em>codeine & acetaminophen</em> (Tylenol with Codeine, Tylenol #3, Tylenol #4) CIII as a tablet and C5 as an oral solution - tablet, oral solution<br /><em>fentanyl</em> (Duragesic, Sublimaze, Actiq) CII - transdermal patch, injectable solution, sublingual tablet, buccal tablet, buccal film, sublingual solution, lollipop <br /><em>hydrocodone & acetaminophen</em> (Vicodin, Lorcet) CIII - capsule, tablet, oral solution, oral elixir<br /><em>hydromorphone</em> (Dilaudid) CII - tablet, extended-release tablet, injectable solution, oral solution, suppository, powder for injection<br /><em>meperidine</em> (Demerol) CII - tablet, injectable solution, syrup<br /><em>methadone</em> (Methadose, Dolophine) CII - tablet, dispersible tablet, oral solution, injectable solution<br /><em>morphine</em> (MS Contin, Duramorph, Kadian) CII - tablet, extended-release capsule, controlled-release tablet, oral solution, injectable solution, suppository<br /><em>oxycodone</em> (OxyContin, Roxicodone) CII - tablet, capsule, extended-release tablet, oral solution<br /><em>oxycodone & acetaminophen</em> (Percocet, Tylox, Roxicet) CII - tablet, capsule, oral solution<br /><em>tramadol</em> (Ultram) not federally scheduled - tablet, orally-disintegrating tablet, extended-release tablet, extended-release capsule <br /><em>tramadol & acetaminophen</em> (Ultracet) not federally scheduled - tablet</p>
| + | |
| − | <p><strong>Non Steroidal Anti Inflammatory Drugs</strong></p>
| + | |
| − | <p>Nonsteroidal anti-inflammatory drugs, usually abbreviated to NSAIDs are a class of drugs that provide analgesic and antipyretic effects, and, in higher doses, anti-inflammatory effects. NSAIDs are usually indicated for the treatment of acute or chronic conditions where pain and inflammation are present such as rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, gout, dysmenorrhoea, headache and migraine, postoperative, inflammation, muscle stiffness, and fever.</p>
| + | |
| − | <p><em>celecoxib</em> (Celebrex) - capsule<br /><em>diclofenac</em> (Voltaren, Cataflam) - tablet, extended-release tablet, capsule, powder packet for oral solution<br /><em>ibuprofen</em> (Advil, Motrin) - tablet, chewable tablet, oral suspension, injection solution<br /><em>ketorolac</em> (Toradol) - tablet, injectable solution<br /><em>naproxen</em> (Aleve, Naprosyn, Anaprox, Naprelan) - tablet, oral suspension<br /><em>meloxicam</em> (Mobic) - tablet, oral suspension<br /><em>nabumetone</em> (Relafen) - tablet <br /><em>piroxicam</em> (Feldene) - capsule</p>
| + | |
| − | <p><strong>Miscellaneous Nonopioid Analgesics</strong></p>
| + | |
| − | <p>Some medications do not easily fit into other categories such as acetaminophen, aspirin and some of the combination analgesics that contain weak barbiturates.</p>
| + | |
| − | <p>Acetaminophen, sometimes listed as APAP, is a potent analgesic and antipyretic activity with weak anti-inflammatory activity. Acetaminophen-containing products pose a potential to harm liver function and therefor patients are not to exceed a cumulative dose of 4 g/day of acetaminophen. In January 2011, the FDA mandated that all manufacturers limit acetaminophen in prescription products to 325 mg/dosage unit; manufacturers have until January 14, 2014, to comply.</p>
| + | |
| − | <p>Aspirin, sometimes listed as ASA, inhibits the synthesis of prostaglandin by cyclooxygenase; inhibits platelet aggregation; has antipyretic and analgesic activity. While aspirin could technically be classified as a NSAID, it is more often classified as a salicylate.</p>
| + | |
| − | <p>One thing that surprises many about the combination of butalbital, acetaminophen, and caffeine is that it is not federally scheduled even though butalbital, aspirin, and caffeine is considered a controlled substance.</p>
| + | |
| − | <p><em>acetaminophen</em> (Tylenol) - tablet, extended-release tablet, chewable tablet, disintegrating tablet, elixir, suspension, suppository<br /><em>aspirin</em> (Bayer, Ascriptin, Bufferin, Ecotrin, St. Joseph Adult Chewable Aspirin) - tablet, delayed-release tablet, effervescent tablet, chewable tablet, suppository <br /><em>butalbital, acetaminophen, & caffeine</em> (Fioricet) - tablet, capsule, oral solution<br /><em>butalbital, aspirin, & caffeine</em> (Fiorinal) CIII - tablet, capsule</p>
| + | |
| − | <p><strong>Serotonin 5-HT Receptor Agonist</strong></p>
| + | |
| − | <p>Serotonin 5-HT receptor agonists cause vasoconstriction in cranial arteries to relieve migraines and cluster headaches.</p>
| + | |
| − | <p><em>rizatriptan</em> (Maxalt) - tablet, disintegrating tablet<br /><em>sumatriptan</em> (Imitrex) - tablet, nasal spray, injectable solution<br /><em>zolmitriptan</em> (Zomig) - tablet, disintegrating tablet, nasal spray</p>
| + | |
| − | <p><em>Quick review question 20<br /></em></p>
| + | |
| − | <p>Which of the following opioid pain relievers is also used to treat opioid addiction?</p>
| + | |
| − | <p> a. meperidine<br /> b. buprenorphine & naloxone<br /> c. Vicodin<br /> d. tramadol</p>
| + | |
| − | <p><em>Quick review question 21<br /></em></p>
| + | |
| − | <p>Which of the following NSAIDs is available as an injectable solution?</p>
| + | |
| − | <p> a. celecoxib<br /> b. diclofenac<br /> c. ketorolac<br /> d. meloxicam</p>
| + | |
| − | <p><em>Quick review question 22<br /></em></p>
| + | |
| − | <p>Serotonin 5-HT agonists are primarily indicated for which of the following conditions?</p>
| + | |
| − | <p> a. migraines<br /> b. fever<br /> c. platelet aggregation<br /> d. none of the above</p>
| + | |
| − | <h3>Medications affecting the cardiac system</h3>
| + | |
| − | <p><strong>Cardiac Glycosides</strong></p>
| + | |
| − | <p>Cardiac glycosides are drugs used in the treatment of congestive heart failure and cardiac arrhythmia.</p>
| + | |
| − | <p><em>digoxin</em> (Lanoxin) - elixir, tablet, injectable solution</p>
| + | |
| − | <p><strong>Diuretics</strong></p>
| + | |
| − | <p>A diuretic elevates the rate of urination which removes fluid from the body and has a net result of decreased blood pressure. There are various mechanisms of action for these diuretics. Loop diuretics, such as bumetanide and furosemide, inhibit the reabsorption of sodium and chloride ions in the ascending loop of Henle within the kidneys' nephrons. By decreasing this reabsorption an increased amount of fluid is excreted. Thiazide diuretics, such as chlorothiazide and hydrochlorothiazide (often abbreviated HCTZ), inhibit sodium reabsorption in distal renal tubules resulting in increased excrertion of sodium and water. Loop diuretics and thiazide diuretics also cause patients to lose a lot of potassium. Potassium sparing diuretics, such as spironolactone and triamterene, have an effect on renal distal tubules to inhibit sodium reabsorption causing the excretion of sodium and water but allows for the retention of potassium.</p>
| + | |
| − | <p><em>bumetanide</em> (Bumex) - tablet, injectable solution<br /><em>chlorothiazide</em> (Diuril) - tablet, powder for injection<br /><em>furosemide</em> (Lasix) - tablet, oral solution, injectable solution<br /><em>hydrochlorothiazide</em> (Microzide) - tablet, capsule<br /><em>spironolactone</em> (Aldactone) - tablet<br /><em>triamterene & hydrochlorothiazide</em> (Dyazide, Maxzide) - tablet, capsule</p>
| + | |
| − | <p><strong>Antiarrhythmics</strong></p>
| + | |
| − | <p>Antiarrhythmic agents are a group of pharmaceuticals that are used to suppress abnormal rhythms of the heart (cardiac arrhythmias), such as atrial fibrillation, atrial flutter, ventricular tachycardia, and ventricular fibrillation.</p>
| + | |
| − | <p><em>cordarone</em> (Amiodarone) - tablet, injectable solution <br /><em>dofetilide</em> (Tikosyn) - capsule</p>
| + | |
| − | <p><strong>Angiotensin-II Receptor Antagonists</strong></p>
| + | |
| − | <p>Angiotensin-II receptor antagonists (AIIRAs), also called angiotensin receptor blockers (ARBs), are a group of pharmaceuticals which modulate the renin-angiotensin-aldosterone system. Their main uses are in the treatment of hypertension (high blood pressure), diabetic nephropathy (kidney damage due to diabetes) and congestive heart failure.</p>
| + | |
| − | <p><em>candesartan</em> (Atacand) - tablet <br /><em>irbesartan</em> (Avapro) - tablet <br /><em>losartan</em> (Cozaar) - tablet <br /><em>olmesartan</em> (Benicar) - tablet <br /><em>telmisartan</em> (Micardis) - tablet <br /><em>valsartan</em> (Diovan) - tablet</p>
| + | |
| − | <p><strong>Angiotensin-Converting Enzyme Inhibitors</strong></p>
| + | |
| − | <p>Angiotensin-converting enzyme inhibitors (ACE inhibitors) causes dilation of blood vessels which results in lower blood pressure. In treating heart disease ACE inhibitors are usually used with other medications. A typical treatment plan will often include an ACE inhibitor, beta blocker, a long acting nitrate and a calcium channel blocker in combinations that are adjusted to the individual patient's needs.</p>
| + | |
| − | <p><em>benazepril</em> (Lotensin) - tablet<br /><em>captopril</em> (Capoten) - tablet<br /><em>enalapril/enalaprilat</em> (Vasotec) - tablet, injectable solution <br /><em>fosinopril</em> (Monopril) - tablet<br /><em>lisinopril</em> (Prinivil, Zestril) - tablet<br /><em>quinapril</em> (Accupril) - tablet<br /><em>ramipril</em> (Altace) - capsule</p>
| + | |
| − | <p><strong>Calcium Channel Blockers</strong></p>
| + | |
| − | <p>These drugs are used to treat hypertension. Calcium channel blockers work by inhibiting the influx of calcium ions into myocardial and vascular tissues thereby preventing contractions and causing the dilation of the main coronary and systemic arteries.</p>
| + | |
| − | <p><em>amlodipine</em> (Norvasc) - tablet<br /><em>diltiazem</em> (Cardizem) - tablet, extended-release tablet, extended-release capsule, injectable solution, powder for injection<br /><em>felodipine</em> (Plendil) - extended-release tablet<br /><em>nifedipine</em> (Procardia, Adalat) - capsule, extended-release tablet<br /><em>verapamil</em> (Isoptin, Calan, Covera HS) - tablet, extended-release tablet, extended-release capsule, injectable solution</p>
| + | |
| − | <p><strong>Nitrates</strong></p>
| + | |
| − | <p>Nitrates relax smooth muscle via dose-dependent dilation of arterial and venous beds to reduce both preload and afterload, and myocardial oxygen demand. Nitrates also improves coronary collateral circulation, lowers blood pressure, and increases heart rate. Nitrates are used for both the relief and prevention of angina pectoris, treatment of perioperative hypertension, control of congestive heart failure during a myocardial infarction and you will see these used off label for the treatment of anal fissures. Typically, patients need a nitrate free interval to minimize tolerance. This nitrate free interval is often provided at night.</p>
| + | |
| − | <p><em>isosorbide</em> (Isordil, Dilatrate-SR, Imdur, ISMO, Monoket) - tablet, sublingual tablet, extended-release tablet, extended-release capsule<br /><em>nitroglycerin</em> (Nitrostat, Nitrol, NitroDur, Nitro-Bid, Nitrolingual Pumpspray) - sublingual tablet, extended-release capsule, translingual solution, transdermal patch, intravenous solution, transdermal ointment, rectal ointment </p>
| + | |
| − | <p><strong>Renin Inhibitor</strong></p>
| + | |
| − | <p>A renin inhibitor prevents the conversion of angiotensinogen to angiotensin I. The decrease in antiotensin I causes a decrease in angiotensin II, a potent blood pressure elevating peptide. This makes renin inhibitors effective in the treatment of hypertension.</p>
| + | |
| − | <p><em>aliskiren</em> (Tekturna) - tablet</p>
| + | |
| − | <p><strong>Combination Antihypertensive Agents</strong></p>
| + | |
| − | <p>Many antihypertensive medications are provided in combinations in order to combine effects and improve patient compliance by decreasing the number of medications the patient may need to take. As all the medications listed below have already been discussed in this chapter, you may refer to the previous information concerning each active ingredient within the combination medications listed below.</p>
| + | |
| − | <p><em>aliskiren & hydrochlorothiazide</em> (Tekturna HCT) - tablet<br /><em>amlodipine & benazepril</em> (Lotrel) - capsule<br /><em>amlodipine & valsartan</em> (Exforge) - tablet<br /><em>bisoprolol & hydrochlorothiazide</em> (Ziac) - tablet<br /><em>enalapril & hydrochlorothiazide</em> (Vaseretic) - tablet<br /><em>irbesartan & hydrochlorothiazide</em> (Avalide) - tablet<br /><em>lisinopril & hydrochlorothiazide</em> (Prinzide, Zestoretic) - tablet<br /><em>losartan & hydrochlorothiazide</em> (Hyzaar) - tablet<br /><em>olmesartan & hydrochlorothiazide</em> (Benicar HCT) - tablet<br /><em>telmisartan & hydrochlorothiazide</em> (Micardis HCT) - tablet<br /><em>valsartan & hydrochlorothiazide</em> (Diovan HCT) - tablet</p>
| + | |
| − | <p><strong>Anticoagulants and Antiplatelet Agents</strong></p>
| + | |
| − | <p>A broad range of chemicals with various mechanisms of action fall into this category. Anticoagulants and antiplatelet drugs are used for the following treatments: prophylaxis after a myocardial infarction or stroke (aspirin & dipyridamole, clopidogrel, warfarin), acute coronary syndrome (clopidogrel, heparin), peripheral arterial disease (clopidogrel), coronary artery disease (clopidogrel), stenting (clopidogrel), atrial fibrilation (dabigatran, warfarin), thromboembolism (dabigatran, dalteparin), deep vein thrombosis (dalteparin, enoxaparin, heparin, warfarin), pulmonary embolism (heparin, warfarin), unstable angina (dalteparin, enoxaparin, heparin), anticoagulation therapy (dalteparin, heparin), catheter patency (heparin), cardiac valve replacement (warfarin). Below is a short list of the most common anticoagulants and antiplatelet agents.</p>
| + | |
| − | <p><em>aspirin & dipyridamole</em> (Aggrenox) - extended-release capsule<br /><em>clopidogrel</em> (Plavix) - tablet<br /><em>dabigatran</em> (Pradaxa) - capsule<br /><em>dalteparin</em> (Fragmin) - injectable solution<br /><em>enoxaparin</em> (Lovenox) - injectable solution<br /><em>heparin</em> - heparin lock solution, injectable solution, premixed IV solution<br /><em>warfarin</em> - (Coumadin) - tablet, powder for injection</p>
| + | |
| − | <p><strong>HMG-CoA Reductase Inhibitors</strong></p>
| + | |
| − | <p>HMG-CoA reductase inhibitors (commonly referred to as statins) block the pathway for synthesizing cholesterol in the liver. This is significant because most circulating cholesterol comes from internal manufacture rather than the diet. When the liver can no longer produce cholesterol, total levels of cholesterol in the blood will fall, particularly LDL-cholesterol and triglycerides. They also increase "good cholesterol" -- HDL cholesterol. Cholesterol synthesis appears to occur mostly at night, so statins with short half-lives are usually taken at night to maximize their effect. The most common adverse side effects are raised liver enzymes and muscle problems (most frequently muscle cramps).</p>
| + | |
| − | <p><em>atorvastatin</em> (Lipitor) - tablet<br /><em>fluvastatin</em> (Lescol, Lescol XL) - capsule, extended-release tablet<br /><em>lovastatin</em> (Mevacor, Altoprev) - tablet, extended-release tablet<br /><em>pravastatin</em> (Pravachol) - tablet<br /><em>rosuvastatin</em> (Crestor) - tablet<br /><em>simvastatin</em> (Zocor) - tablet</p>
| + | |
| − | <p><strong>Miscellaneous Hypolipidemic Drugs</strong></p>
| + | |
| − | <p>There are a number of other medications used to reduce cholesterol with various mechanisms of action. Caduet (amlodipine & atorvastatin) are used in combination to treat both hypertension and reduce cholesterol.</p>
| + | |
| − | <p><em>amlodipine & atorvastatin</em> (Caduet) - tablet <br /><em>ezetimibe</em> (Zetia) - tablet <br /><em>fenofibrate</em> (Tricor) - tablet, capsule <br /><em>gemfibrozil</em> (Lopid) - tablet <br /><em>niacin, vitamin B3, nicotinic acid</em> (Niacor, Niaspan) - tablet, extended-release tablet, extended-release capsule <br /><em>omega 3 fatty acids</em> (Lovaza) - chewable tablet, capsule, delayed-release capsule <br /><em>simvastatin & ezetimibe</em> (Vytorin) - tablet</p>
| + | |
| − | <p><em>Quick review question 23<br /></em></p>
| + | |
| − | <p>Which of the following is considered a potassium sparing diuretic?</p>
| + | |
| − | <p> a. Lasix<br /> b. HCTZ<br /> c. Aldactone<br /> d. Tikosyn</p>
| + | |
| − | <p><em>Quick review question 24<br /></em></p>
| + | |
| − | <p>Which of the following is the generic name for Avapro?</p>
| + | |
| − | <p> a. irbesartan<br /> b. losartan<br /> c. telmisartan<br /> d. valsartan</p>
| + | |
| − | <p><em>Quick review question 25<br /></em></p>
| + | |
| − | <p>Which of the following antihypertensive medications is considered a calcium channel blocker?</p>
| + | |
| − | <p> a. Capoten<br /> b. Cardizem<br /> c. Coreg<br /> d. Dilatrate-SR</p>
| + | |
| − | <p><em>Quick review question 26<br /></em></p>
| + | |
| − | <p>Which of the anticoagulants listed below are available in an oral formulation?</p>
| + | |
| − | <p> a. dalteparin<br /> b. enoxaparin<br /> c. heparin<br /> d. warfarin</p>
| + | |
| − | <p><em>Quick review question 27<br /></em></p>
| + | |
| − | <p>Atorvastatin is used to:</p>
| + | |
| − | <p> a. increase triglyceride levels<br /> b. increase LDL cholesterol<br /> c. decrease HDL cholesterol<br /> d. decrease total levels of cholesterol</p>
| + | |
| − | <h3>Antihistamines</h3>
| + | |
| − | <p>Colds and allergy sufferers may desire symptomatic relief from antihistamine and decongestants.</p>
| + | |
| − | <p><strong>Antihistamine</strong></p>
| + | |
| − | <p>Antihistamines are commonly used for the relief of various allergic reaction including allergic rhinitis, perennial & seasonal allergies, pruritus, and allergic conjunctivitis. First generation antihistamines (diphenhydramine and hydroxyzine) can cross the blood brain barrier. As a result, diphenhydramine may be used to treat insomnia and hydroxyzine may be used to treat nausea and vomiting.</p>
| + | |
| − | <p><em>cetririzine</em> (Zyrtec) - tablet, chewable tablet, capsule, oral solution <br /><em>desloratadine</em> (Clarinex, Clarinex RediTabs) - tablet, disintegrating tablet, syrup <br /><em>diphenhydramine</em> (Benadryl) - tablet, chewable tablet, disintegrating tablet, capsule, oral solution, cream, gel, ointment, lotion, topical aerosol spray, oral strip, injectable solution <br /><em>fexofenadine</em> (Allegra) - tablet, disintegrating tablet, oral suspension <br /><em>hydroxyzine</em> (Vistaril) - tablet, capsule, syrup, oral suspension, injectable solution <br /><em>loratadine</em> (Claritin) - tablet, chewable tablet, disintegrating tablet, capsule, oral solution <br /><em>olopatadine</em> (Patanol, Patanase) - ophthalmic drops, nasal spray</p>
| + | |
| − | <p><strong>Antihistamines and Decongestants</strong></p>
| + | |
| − | <p>Patients with either colds or congestion related to their allergies may desire an antihistamine in combination with a decongestant. Since pseudoephedrine is the most commonly included decongestant many of the medications need to be kept behind the counter in order to limit their availability. This is a result of the Combat Methamphetamine Epidemic Act which will be discussed further in the next chapter.</p>
| + | |
| − | <p><em>cetirizine & pseudoephedrine</em> (Zyrtec D) - tablet, extended-release tablet <br /><em>desloratadine & pseudoephedrine</em> (Clarinex-D) - extended-release tablet <br /><em>fexofenadine & pseudoephedrine</em> (Allegra D) - extended-release tablet <br /><em>loratadine & pseudoephedrine</em> (Claritin D) - extended-release tablet</p>
| + | |
| − | <p><em>Quick review question 28<br /></em></p>
| + | |
| − | <p>Which antihistamine is sometimes prescribed to treat insomnia?</p>
| + | |
| − | <p> a. cetirizine<br /> b. diphenhydramine<br /> c. fexofenadine<br /> d. olopatadine</p>
| + | |
| − | <h3>Respiratory medications</h3>
| + | |
| − | <p>Some patients may have respiratory conditions such as asthma or bronchitis. Patients may receive glucocorticosteroids, bronchodialators, leukotriene receptor antagonists, or even epinephrine to treat or prevent acute episodes. Glucocorticosteroids and epinephrine have already been discussed in this chapter, therefore this section will focus on bronchodialators and leukotriene receptor antagonists.</p>
| + | |
| − | <p><strong>Bronchodialators</strong></p>
| + | |
| − | <p>A bronchodilator is a substance that dilates the bronchi and bronchioles, decreasing resistance in the respiratory airway and increasing airflow to the lungs. The bronchodialators on this list can be further broken down into beta-2 agonists (albuterol, levalbuterol, and salmeterol) and anticholinergics (ipratropium and tiotropium). Fluticasone, which may be used on it own or in combination with other drugs is classified as a glucocorticosteroid.</p>
| + | |
| − | <p><em>albuterol</em> (Proventil, Ventolin, Proair) - tablet, oral liquid, inhalation aerosol, solution for nebulization <br /><em>albuterol & ipratropium</em> (Combivent, DuoNeb) - inhalation aerosol, solution for nebulization <br /><em>budesonide & formoterol</em> (Symbicort) - inhalation aerosol<br /><em>salmeterol & fluticasone</em> (Advair Diskus, Advair HFA) - disk with powder for inhalation, inhalation aerosol <br /><em>ipratropium</em> (Atrovent) - inhalation aerosol, solution for nebulization, nasal spray <br /><em>levalbuterol</em> (Xopenex) - inhalation aerosol, solution for nebulization <br /><em>tiotropium</em> (Spiriva) - capsules for inhalation</p>
| + | |
| − | <p><strong>Miscellaneous Asthma Treatments</strong></p>
| + | |
| − | <p>Leukotriene receptor antagonists <span>have been shown to improve asthma symptoms, reduce asthma exacerbations and limit markers of inflammation. These medications are also used for allergies.</span></p>
| + | |
| − | <p><em>montelukast</em> (Singulair) - tablet, chewable tablet, granules for suspension <br /><em>zafirlukast</em> (Accolate) - tablet</p>
| + | |
| − | <p><em>Quick review question 29<br /></em></p>
| + | |
| − | <p>Which of the following medications require a special device for patients to inhale capsules?</p>
| + | |
| − | <p> a. Proventil<br /> b. Combivent<br /> c. Spiriva<br /> d. Singulair</p>
| + | |
| − | <h3>Medications affecting the Gastrointestinal System</h3>
| + | |
| − | <p>The gastrointestinal system stretches from mouth to anus and includes the esophagus, stomach, and intestines. The long portion of the body can have a plethora of ailments from heart burn and reflux to stomach and duodenal ulcers to emesis and diarrhea. This section endeavors to look at some of the more common medications utilized to cover these conditions.</p>
| + | |
| − | <p><strong>H2-Receptor Antagonists</strong></p>
| + | |
| − | <p>H2-receptor antagonists are used to block the action of histamine on parietal cells in the stomach, decreasing the production of acid by these cells. H2-antagonists are used for peptic ulcer disease (PUD) gastroesophageal reflux disease (GERD), dyspepsia and the prevention of stress ulcers.</p>
| + | |
| − | <p><em>cimetidine</em> (Tagamet) - tablet, oral solution <br /><em>famotidine</em> (Pepcid) - tablet, chewable tablet, oral suspension, injectable solution, premixed IV bag <br /><em>nizatidine</em> (Axid) - capsule, oral solution <br /><em>ranitidine</em> (Zantac) - tablet, chewable tablet, effervescent tablet, capsule, syrup, injectable solution, premixed IV bag</p>
| + | |
| − | <p><strong>Proton Pump Inhibitors</strong></p>
| + | |
| − | <p>Proton-pump inhibitors (PPIs) produce a pronounced and long-lasting reduction of gastric acid production. These drugs are used to treat dyspepsia, peptic ulcer disease (PUD), gastroesophageal reflux disease (GERD), laryngopharyngeal reflux, Barrett's esophagus, stress gastritis prevention, gastrinomas and other conditions that cause hypersecretion of acid, and Zollinger-Ellison syndrome.</p>
| + | |
| − | <p><em>dexlansoprazole</em> (Dexilant) - delayed-release capsule <br /><em>esomeprazole</em> (Nexium) - delayed-release capsule, granules for suspension, injectable solution <br /><em>lansoprazole</em> (Prevacid) - disintegrating tablet, delayed-release capsule, oral suspension <br /><em>omeprazole</em> (Prilosec) - delayed-release tablet, delayed-release capsule, oral suspension, powder for oral suspension <br /><em>pantoprazole</em> (Protonix) - delayed-release tablet, powder for oral suspension, powder for injection <br /><em>rabeprazole</em> (Aciphex) - delayed-release tablet</p>
| + | |
| − | <p><strong>Antiemetics</strong></p>
| + | |
| − | <p>Antiemetics are used to treat nausea and vomiting associated with a number of things including motion sickness, the side effects of opioid analgesics and general anesthetics, and chemotherapy directed against cancer. Antiemetics are also used for morning sickness, but there is little information about the effect on the fetus, and therefore are typically reserved for times considered strictly necessary.</p>
| + | |
| − | <p><em>aprepitant</em> (Emend) - capsule <br /><em>dolasetron</em> (Anzemet) - tablet, injectable solution <br /><em>dronabinol</em> (Marinol) CIII - capsule <br /><em>granisetron</em> (Kytril) tablet, transdermal patch, injectable solution <br /><em>meclizine</em> (Antivert, Bonine) - tablet, chewable tablet <br /><em>metoclopramide</em> (Reglan) - tablet, dispersible tablet, oral solution, injectable solution <br /><em>prochlorperazine</em> (Compazine) - tablet, suppository, injectable solution <br /><em>promethazine</em> (Phenergan) - oral tablet, syrup, injectable solution, suppository <br /><em>ondansetron</em> (Zofran) - tablet, dispersible tablet, oral solution, oral film, injectable solution <br /><em>scopolamine</em> (Transderm Scop) - tablet, transdermal patch, ophthalmic solution, injectable solution <br /><em>trimethobenzamide</em> (Tigan) - capsule, intramuscular solution</p>
| + | |
| − | <p><strong>Stool Softener and Laxatives</strong></p>
| + | |
| − | <p>Stool softeners and laxatives are taken to loosen stool and treat constipation. Some laxatives are used to evacuate the colon for rectal and/or bowel examinations.</p>
| + | |
| − | <p><em>bisacodyl</em> (Dulcolax) - delayed-release tablet, suppository, enema <br /><em>docusate</em> (Colace) - tablet, capsule, syrup <br /><em>docusate & senna</em> (Peri-Colace, Senokot-S) - tablet <br /><em>lactulose</em> (Enulose, Kristalose) - oral solution, powder for oral solution <br /><em>polyethylene glycol</em> (MiraLax, Glycolax) - powder for oral solution <br /><em>polyethylene glycol with electrolytes</em> (GoLytely) - oral solution, powder for oral solution<br /><em>psyllium</em> (Metamucil) - powder for oral solution<br /><em>senna</em> (Senokot) - tablet, chewable tablet, syrup</p>
| + | |
| − | <p><em>Quick review question 30<br /></em></p>
| + | |
| − | <p>Which of the following antiemetics is often used for motion sickness and is available as a patch ?</p>
| + | |
| − | <p> a. scopolamine<br /> b. trimethobenzamide<br /> c. ondansetron<br /> d. dexlansoprazole</p>
| + | |
| − | <p><em>Quick review question 31<br /></em></p>
| + | |
| − | <p>Which of the following is an H2-receptor antagonist?</p>
| + | |
| − | <p> a. Protonix<br /> b. Prilosec<br /> c. Prevacid<br /> d. Pepcid</p>
| + | |
| − | <h3>Drugs affecting the thyroid gland and bone degeneration</h3>
| + | |
| − | <p>The thyroid gland secretes three hormones, triiodothyronine (T<sub>3</sub>), thyroxine (T<sub>4</sub>), and thyrocalcitonin. Triiodothyronine and thyroxine help regulate tissue growth and mitochondrial metabolism in most of the cells in the human body. Thyrocalcitonin primarily affect bone formation.</p>
| + | |
| − | <p><strong>Thyroid Replacement Therapy</strong></p>
| + | |
| − | <p>Thyroid replacement therapies are primarily used to treat hypothyroidism. These therapies use medications that replace T3 (liothyronine), T4 (levothyroxine), or both T3 and T4 (thyroid). </p>
| + | |
| − | <p><em>levothyroxine</em> (Synthroid, Levoxyl, Levothroid) - tablet, capsule, powder for injection<br /><em>thyroid</em> (Armour Thyroid) - tablet<br /><em>liothyronine</em> (Cytomel, Triostat) - tablet, injectable solution</p>
| + | |
| − | <p><strong>Osteoporosis Therapy</strong></p>
| + | |
| − | <p>Osteoporosis and Paget's Disease are diseases in which bones have decreased mass and and are more fragile. While calcium and vitamin D (both discussed further when talking about dietary supplements in a later section) are important to developing and maintaining strong bones, other medications are used to specifically combat these diseases such as calcitonin (used to supplement thyrocalcitonin), bisphosphonate derivatives (such as ibandronate, risedronate, and zoledronic acid), and parathyroid hormone analog (teriparatide). Patients should be instructed to remain upright for 60 minutes after taking a bisphosphonate derivative to prevent stomach upset and inflammation and erosion of the esophagus. </p>
| + | |
| − | <p><em>alendronate</em> (Fosamax) - tablet, weekly tablet, effervescent tablet, oral solution<br /><em>calcitonin</em> (Miacalcin, Fortical) - injectable solution, nasal spray<br /><em>ibandronate</em> (Boniva) - monthly tablet, prefilled syringe<br /><em>risedronate</em> (Actonel) - tablet, weekly tablet<br /><em>teriparatide</em> (Forteo) - prefilled injectable pen<br /><em>zoledronic acid</em> (Reclast, Zometa) - injectable solution</p>
| + | |
| − | <p><em>Quick review question 32<br /></em></p>
| + | |
| − | <p>Paget's Disease affect which of the following?</p>
| + | |
| − | <p> a. GI tract<br /> b. mitochondrial metabolism<br /> c. bones<br /> d. liver</p>
| + | |
| − | <p><em>Quick review question 33<br /></em></p>
| + | |
| − | <p>Which of the following drugs would not be used to treat hypothyroidism?</p>
| + | |
| − | <p> a. levothyroxine<br /> b. lansoprazole<br /> c. thyroid<br /> d. liothyronine</p>
| + | |
| − | <h3>Medications for treating diabetes mellitus</h3>
| + | |
| − | <p>Diabetes mellitus refers to a group of diseases that affect how your body uses blood glucose, commonly called blood sugar. There are two primary types of this disease, type 1 diabetes and type 2 diabetes. </p>
| + | |
| − | <p>Type 1 diabetes, also known as insulin dependent diabetes mellitus (IDDM) or juvenile diabetes, typically appears during childhood or adolescence. Individuals with type 1 diabetes require insulin therapy as their bodies do not produce insulin.</p>
| + | |
| − | <p>Type 2 diabetes, also known as non-insulin dependent diabetes mellitus (NIDDM), usually occurs in adults. Individuals with type 2 diabetes either don't produce enough insulin or their cells have become insulin resistant. These patients will usually receive non-insulin therapies, although they may receive insulin therapy, or even a combination of insulin and non-insulin therapies.</p>
| + | |
| − | <p><strong>Insulins</strong></p>
| + | |
| − | <p>Insulin therapy is required in type 1 diabetes, and may be necessary in some individuals with type 2 diabetes. The general objective of insulin replacement therapy is to approximate the physiological pattern of insulin secretion. This requires a basal insulin throughout the day, supplemented by prandial insulin at mealtime. Insulin injections are intended to mimic the natural process shown in the following image.</p>
| + | |
| − | <p>A combination of rapid-acting (insulin aspart, insulin glulisine, insulin lispro) or short-acting (insulin regular) given in combination with either an intermediate-acting (insulin NPH) or long-acting (insulin detemir, insulin glargine) insulin are typically used. Sometimes an insulin vial or prefilled syringe may have a mixture of insulins (insulin aspart protamine & insulin aspart, insulin lispro protamine & insulin lispro, insulin NPH & insulin regular human) to help reduce the number of injections a patient requires. </p>
| + | |
| − | <p><em>insulin aspart</em> (NovoLog) - vial for injection, prefilled pen<br /><em>insulin aspart protamine & insulin aspart</em> (NovoLog Mix 50/50, Novolog Mix 70/30) - vial for injection, prefilled pen<br /><em>insulin detemir</em> (Levemir) - vial for injection, prefilled pen<br /><em>insulin glargine</em> (Lantus) - vial for injection, prefilled pen<br /><em>insulin glulisine</em> (Apidra) - vial for injection, prefilled pen<br /><em>insulin lispro</em> (Humalog) - vial for injection, prefilled pen<br /><em>insulin lispro protamine & insulin lispro</em> (Humalog Mix 50/50, Humalog Mix 75/25) - vial for injection, prefilled pen<br /><em>insulin NPH</em> (Humulin N, Novlin N) - vial for injection, prefilled pen <br /><em>insulin NPH & insulin regular human</em> (Humulin 70/30, Novolin 70/30) - vial for injection, insulin pen<br /><em>insulin regular human</em> (Humulin R, Novolin R) - vial for injection, prefilled pen, concentrated vial for injection</p>
| + | |
| − | <p><strong>Biguanide</strong></p>
| + | |
| − | <p>Metformin decreases hepatic glucose production, decreases GI glucose absorption, and increases target cell insulin sensitivity. These medication have a cross-sensitivity with sulfa allergies.</p>
| + | |
| − | <p><em>metformin</em> (Glucaphage, Glucophage XR) - tablet, extended-release tablet, oral solution</p>
| + | |
| − | <p><strong>Sulfonylureas</strong></p>
| + | |
| − | <p>Sulfonylureas initially increase insulin secretion, increase insulin receptor sensitivity, and may decrease liver production of glucose. Some patients increased risk of hypoglycemia from sulfonylureas.</p>
| + | |
| − | <p><em>glimepiride</em> (Amaryl) - tablet<br /><em>glipizide</em> (Glucotrol, Glucotrol XL) - tablet, extended-release tablet<br /><em>glyburide</em> (Diabeta, Glynase, Micronase) - tablet, micronized tablet</p>
| + | |
| − | <p><strong>Metaglitinide</strong></p>
| + | |
| − | <p>Metaglitinides increase insulin secretion.</p>
| + | |
| − | <p><em>repaglinide</em> (Prandin) - tablet<br /><em>nateglinide</em> (Starlix) - tablet</p>
| + | |
| − | <p><strong>Thiazolidinediones</strong></p>
| + | |
| − | <p>Thiazolidinediones improve cellular response to insulin and decreases the livers production of glucose. Thiazolidinediones, particularly product containing rosiglitazone, may cause or exarcebate congestive heart failure in some patients.</p>
| + | |
| − | <p><em>pioglitazone</em> (Actos) - tablet<br /><em>rosiglitazone</em> (Avandia) -tablet</p>
| + | |
| − | <p><strong>Dipeptidyl Peptidase-4 Inhibitors</strong></p>
| + | |
| − | <p>Dipeptidyl peptidase-4 (DPP-4) degrade incretin hormones. DPP-4 inhibitors increase and prolong incretin hormone activity. Incretins increase insulin release and synthesis.</p>
| + | |
| − | <p><em>linagliptin</em> (Tradjenta) - tablet<br /><em>saxagliptin</em> (Onglyza) - tablet<br /><em>sitagliptin</em> (Januvia) - tablet</p>
| + | |
| − | <p><strong>Glucagonlike Peptide-1 Agonists</strong></p>
| + | |
| − | <p>Glucagonlike peptide-1 mimic incretin, causing an increase in insulin release and synthesis.</p>
| + | |
| − | <p><em>exenatide</em> (Byetta) - injectable solution<br /><em>liraglutide</em> (Victoza) - injectable solution</p>
| + | |
| − | <p><strong>Oral Antidiabetic Combination Drugs</strong></p>
| + | |
| − | <p>Often, type 2 diabetics will require multiple medications. Combination products provide convenience and improved patient compliance.</p>
| + | |
| − | <p><em>glipizide & metformin</em> (Metaglip) - tablet<br /><em>glyburide & metformin</em> (Glucovance) - tablet<br /><em>sitagliptin & metformin</em> (Janumet) - tablet</p>
| + | |
| − | <p><em>Quick review question 34<br /></em></p>
| + | |
| − | <p>Which of the following medications would not be of benefit to a type 1 diabetic?</p>
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| − | <p> a. Byetta<br /> b. Apidra<br /> c. Lantus<br /> d. Humulin R</p>
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| − | <p><em>Quick review question 35<br /></em></p>
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| − | <p>A type 2 diabetic that has previously had an allergic reaction to Bactrim should not receive which of the following medications?</p>
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| − | <p> a. NovoLog Mix 50/50<br /> b. Byetta<br /> c. Amaryl<br /> d. Janumet</p>
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| − | <p><em>Quick review question 36<br /></em></p>
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| − | <p>Type 1 diabetic require insulin coverage to mimic which of the following?</p>
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| − | <p> a. basal insulin<br /> b. prandial insulin<br /> c. both basal and prandial insulin<br /> d. none of the above</p>
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| − | <p><em>Quick review question 37<br /></em></p>
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| − | <p>Metformin does which of the following?</p>
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| − | <p> a. decreases hepatic glucose production<br /> b. decreases GI glucose production<br /> c. increases target cell insulin sensitivity<br /> d. all of the above</p>
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| − | <h3>Antineoplastic agents and monoclonal antibodies</h3>
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| − | <p>Antineoplastics and monoclonal antibodies are types of chemotherapy. Chemotherapy is the use of medications to kill cancer cells. Chemotherapy is used for diffuse tumors and is used after surgery and irradiation of solid tumors in the attempt to eliminate remaining cancer cells that have metastasized.</p>
| + | |
| − | <p><strong>Antineoplastic Agents</strong></p>
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| − | <p>Antineoplastic agents are intended to inhibit uncontrolled new cell growth. Antineoplastic agents are used to treat breast cancer (anastrazole, capecitabine, cyclophosphamide, docetaxel, doxorubicin, exemestane, fluorouracil, gemcitabine, letrozole, leuprolide, mitomycin, paclitaxel, tamoxifen), non-small cell lung cancer (cisplatin, docetaxel, gemcitabine, irinotecan, mitomycin, paclitaxel), small cell lung cancer (carboplatin, doxorubicin, etoposide, paclitaxel, vincristine), pleural sclerosing (bleomycin), brain cancer (paclitaxel, vincristine), head and neck cancer (bleomycin, carboplatin, cisplatin, docetaxel, doxorubicin, fluorouracil, mitomycin, paclitaxel, vinblastine), thyroid cancer (doxorubicin), Hodgkin's disease (bleomycin, etoposide, vinblastine, vincristine), Non-Hodgkin's disease (bleomycin, cyclophophamide, docetaxel, etoposide, paclitaxel, vincristine), lymphoma (bleomycin, carboplatin, vinblastine, vincristine), leukemia (daunorubicin, etoposide), meningeal leukemia (methotrexate), lymphoblastic leukemia (methotrexate), osteosarcoma (cisplatin, methotrexate), multiple myeloma (mitomycin), esophageal cancer (cisplatin, fluorouracil, mitomycin, paclitaxel), stomach cancer (docetaxel, doxorubicin, fluorouracil, mitomycin, paclitaxel), colon cancer (capecitabine, fluorouracil, irinotecan, oxaliplatin), colorectal cancer (capecitabine, fluorouracil, irinotecan, oxaliplatin), rectal cancer (fluorouracil, irinotecan), bladder cancer (cisplatin, fluorouracil, gemcitabine, mitomycin, vinblastine, vincristine), urothelial cancer (docetaxel, paclitaxel), ovarian carcinoma (carboplatin, cisplatin, docetaxel, doxorubicin, fluorouracil, gemcitabine, irinotecan, letrozole, oxaliplatin, paclitaxel, vinblastine), cervical cancer (bleomycin, carboplatin, cisplatin, fluorouracil), vulvar cancer (bleomycin), endometrial cancer (cisplatin, fluorouracil), endometriosis (leuprolide), uterine fibroids (leuprolide), testicular carcinoma (bleomycin, carboplatin, cisplatin, etoposide, vinblastine), prostate cancer (cisplatin, docetaxel, doxorubicin, fluorouracil, leuprolide, paclitaxel, vinblastine), penile cancer (bleomycin), pancreatic cancer (bleomycin, fluorouracil, gemcitabine, irinotecan, mitomycin, paclitaxel), kidney cancer (cisplatin), liver cancer (doxorubicin, fluorouracil), melanoma (docetaxel, paclitaxel, vinblastine, vincristine), actinic keratoses (fluorouracil), superficial basal cell carcinoma (fluorouracil), Kaposi's sarcoma (etoposide, paclitaxel, vinblastine, vincristine), rhabdomyosarcoma (vincristine), neuroblastoma (vincristine), neoplasms (methotrexate), Wilm's tumor (etoposide, vincristine), soft tissue sarcoma (docetaxel), malignant neoplastic diseases (cyclophosphamide), psoriasis (methotrexate), nephrotic syndrome (cyclophosphamide), juvenile idiopathic arthritis (cyclophosphamide), rheumatoid arthritis, (methotrexate), lupus nephritis (cyclophosphamide), and systemic sclerosis (cyclophosphamide).</p>
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| − | <p>Unfortunately, antineoplastic agents can not differentiate between cancer cells and healthy cells which is responsible for many of the common side effects from these treatments as there is rapid cell growths in bone marrow, the GI tract, hair follicles, and skin cells. This often results in anemias, nausea, vomiting, diarrhea, hair loss, photosensitivity, and thinner skin. Many of these medications also have their own unique adverse affects. To learn more about these drugs go to <a href="http://reference.medscape.com/drugs/oncology">http://reference.medscape.com/drugs/oncology</a>.</p>
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| − | <p><em>anastrazole</em> (Arimidex) - tablet<br /><em>bleomycin</em> (Blenoxane) - powder for injection<br /><em>capecitabine</em> (Xeloda) - tablet<br /><em>carboplatin</em> (Paraplatin) - powder for injection, injectable solution<br /><em>cisplatin</em> (Platinol) - injectable solution<br /><em>cyclophosphamide</em> (Cytoxan) - powder for injection, tablet<br /><em>daunorubicin</em> (Cerubidine) - injectable solution, powder for injection<br /><em>docetaxel</em> (Taxotere) - injectable solution<br /><em>doxorubicin</em> (Adriamycin) - injectable solution, powder for injection<br /><em>etoposide</em> (VePesid, vp 16) - capsule, injectable solution, powder for injection<br /><em>exemestane</em> (Aromisin) - tablet<br /><em>fluorouracil, 5-FU</em> (Adrucil, Efudex) - injectable solution, cream, topical solution<br /><em>gemcitabine</em> (Gemzar) - powder for injection<br /><em>irinotecan</em> (Camptosar) - injectable solution<br /><em>letrozole</em> (Femara) - tablet<br /><em>leuprolide</em> (Lupron) - solution for injection, prefilled syringe<br /><em>methotrexate, MTX</em> (Trexall, Rheumatrex) - injectable solution, powder for injection, tablet<br /><em>mitomycin</em> (Mitomycin C, Mutamycin) - powder for injection<br /><em>oxaliplatin</em> (Eloxatin) - powder for injection<br /><em>paclitaxel</em> - injectable solution<br /><em>tamoxifen</em> (Nolvadex) - tablet, oral solution<br /><em>vinblastine</em> (Velban) - injectable solution, powder for injection<br /><em>vincristine</em> (Oncovin) - injectable solution</p>
| + | |
| − | <p><strong>Monoclonal antibodies</strong></p>
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| − | <p>Monoclonal antibodies, often referred to as targeted therapy, only works against specific cancer cells. This can reduce or even eliminate many of the side affects, but the medications tend to be very limited as to which cancers they can treat. This is because monoclonal antibodies are monospecific antibodies that are all identical because they are made by immune cells that are all clones of a unique parent cell.</p>
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| − | <p>Monoclonal antibodies are used to treat</p>
| + | |
| − | <p>adalimumab <br />alemtuzumab <br />bevacizumab <br />infliximab <br />palivizumab <br />rituximab <br />trastuzumab</p>
| + | |
| − | <p><em>Quick review question 38<br /></em></p>
| + | |
| − | <p>Question?</p>
| + | |
| − | <p> a. lorem<br /> b. ipsum<br /> c. dolore<br /> d. set</p>
| + | |
| − | <p><em>Quick review question 39<br /></em></p>
| + | |
| − | <p>Question?</p>
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| − | <p> a. lorem<br /> b. ipsum<br /> c. dolore<br /> d. set</p>
| + | |
| − | <h3>Miscellaneous drug categories</h3>
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| − | <p>lorem</p>
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| − | <p><strong>Hemopoietics</strong></p>
| + | |
| − | <p>lorem</p>
| + | |
| − | <p>darbepoetin alfa <br />epoetin alfa <br />filgrastim <br />oprelvekin</p>
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| − | <p><strong>Gouty Arthritis Treatment</strong></p>
| + | |
| − | <p>lorem</p>
| + | |
| − | <p>azathioprine <br />colchicine</p>
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| − | <p><strong>Rheumatoid Arthritis Treatment</strong></p>
| + | |
| − | <p>lorem</p>
| + | |
| − | <p>etanercept</p>
| + | |
| − | <p><strong>PDE-5 Inhibitors</strong></p>
| + | |
| − | <p>lorem</p>
| + | |
| − | <p>sildenafil <br />tadalafil <br />vardenafil</p>
| + | |
| − | <p><strong>Antitussives and Expectorants</strong></p>
| + | |
| − | <p>lorem</p>
| + | |
| − | <p>benzonatate <br />codeine & guaifenesin <br />dextromethorphan <br />guaifenesin <br />guaifenessin & phenylephrine</p>
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| − | <p><strong>Prostaglandins</strong></p>
| + | |
| − | <p>lorem</p>
| + | |
| − | <p>latanoprost</p>
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| − | <p><strong>Estrogens and Progesterones</strong></p>
| + | |
| − | <p>lorem</p>
| + | |
| − | <p>conjugated estrogen <br />desogestrel & ethinyl estradiol <br />drospirenone & ethinyl estradiol <br />estradiol <br />etonogestrel & ethynil estradiol <br />levonorgestrel <br />medroxyprogesterone <br />norelgestromin & ethinyl estradiol <br />norethindrone acetate <br />norethindrone acetate & ethinyl estradiol <br />norgestimate & ethinyl estradiol</p>
| + | |
| − | <p><em>Quick review question 40<br /></em></p>
| + | |
| − | <p>Question?</p>
| + | |
| − | <p> a. lorem<br /> b. ipsum<br /> c. dolore<br /> d. set</p>
| + | |
| − | <p><em>Quick review question 41<br /></em></p>
| + | |
| − | <p>Question?</p>
| + | |
| − | <p> a. lorem<br /> b. ipsum<br /> c. dolore<br /> d. set</p>
| + | |
| − | <p><em>Quick review question 42<br /></em></p>
| + | |
| − | <p>Question?</p>
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| − | <p> a. lorem<br /> b. ipsum<br /> c. dolore<br /> d. set</p>
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| − | <h2>Dietary supplements</h2>
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| − | <h3>Vitamins and electrolytes</h3>
| + | |
| − | <p>lorem</p>
| + | |
| − | <p><strong>Vitamins</strong></p>
| + | |
| − | <p>lorem</p>
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| − | <p>multi-vitamin infusion <br />prenatal vitamins <br />vitamin A <br />vitamin B1, thiamine <br />vitamin B3, niacin <br />vitamin B9, folic acid <br />vitamin B12, cyanocobalamin <br />vitamin C, ascorbic acid <br />vitamin D2, ergocalciferol <br />vitamin D3, cholecalciferol <br />vitamin E, <br />vitamin K1, phytonadione</p>
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| − | <p><strong>Electrolytes</strong></p>
| + | |
| − | <p>lorem</p>
| + | |
| − | <p>calcium <br />iron <br />magnesium <br />multiple trace elements <br />potassium <br />zinc</p>
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| − | <h3>Herbals</h3>
| + | |
| − | <p>lorem</p>
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| − | <p>chondroitin <br />coenzyme Q10 <br />cranberry <br />creatine <br />fish oil <br />glucosamine <br />marijuana <br />phytoestrogens <br />St. John's Wart <br />wild yam </p>
| + | |
| − | <p><em>Quick review question 43<br /></em></p>
| + | |
| − | <p>Question?</p>
| + | |
| − | <p> a. lorem<br /> b. ipsum<br /> c. dolore<br /> d. set</p>
| + | |
| − | <h2>Vaccines</h2>
| + | |
| − | <p>A vaccine is a biological preparation that improves immunity to a particular disease. A vaccine typically contains an agent that resembles a disease-causing microorganism, and is often made from weakened or killed forms of the microbe, its toxins or one of its surface proteins. The agent stimulates the body's immune system to recognize the agent as foreign, destroy it, and "remember" it, so that the immune system can more easily recognize and destroy any of these microorganisms that it later encounters. Vaccines do not guarantee complete protection from a disease. The efficacy or performance of the vaccine is dependent on a number of factors including the disease itself (for some diseases vaccination performs better than for other diseases), the strain of vaccine (some vaccinations are for different strains of the disease), whether one kept to the timetable for the vaccinations, some individuals are "non-responders" (they do not generate antibodies even after being vaccinated correctly), or other factors such as ethnicity, age, or genetic predisposition. When a vaccinated individual does develop the disease vaccinated against, the disease is likely to be milder than without vaccination.</p>
| + | |
| − | <p>lorem</p>
| + | |
| − | <p><em>Quick review question 44<br /></em></p>
| + | |
| − | <p>Question?</p>
| + | |
| − | <p> a. lorem<br /> b. ipsum<br /> c. dolore<br /> d. set</p>
| + | |
This article is intended to provide a broad overview of pharmacology and medications often used in either community or institutional pharmacy settings and is not intended as sole means towards determining diagnosis and/or treatment of an individual.
Pharmacy technicians should be able to categorize drugs into major therapeutic classifications and be able to briefly describe the therapeutic use of each drug. Technicians should also be able to correlate brand name medications with the generic names.
The following subsections will break the drugs down into various therapeutic classes with descriptions of these classes followed by a list of generic drug names accompanied by their most common brand names and commercially available dosage forms. These lists are not to be considered comprehensive, but instead just provide some of the more common items to serve as a quick refresher. If you want more information on a particular drug, an excellent free (registration required) resource is Medscape at http://reference.medscape.com.
An anti-infective (also called an antimicrobial) is a substance that kills or inhibits the growth of microbes such as bacteria, fungi, protozoans or viruses. In this section we will look at antibiotics, antifungals, amebicides, and antivirals.
Bacteria treated by antibiotics are usually broken into two categories, gram positive and gram negative.
Gram-positive bacteria are those that are stained dark blue or violet by Gram staining. This is in contrast to Gram-negative bacteria, which cannot retain the crystal violet stain, instead taking up the counterstain (safranin or fuchsin) and appearing red or pink. Gram-positive organisms are able to retain the crystal violet stain because of the high amount of peptidoglycan in the cell wall. Gram-positive cell walls typically lack the outer membrane found in Gram-negative bacteria.
Penicillin derivatives act by preventing cell wall synthesis during active replication and are therefore bactericidal. Penicillin derivatives have a chemical structure referred to as a beta-lactam ring which is what allows it to attach to the bacteria. Penicillins are used in the treatment of bacterial infections caused by susceptible, usually Gram-positive, organisms. The most common side effects are allergic reactions including rash, hives, or anaphylactic shock.
Sometimes bacteria become resistant to penicillin, and one such mechanism of action for them to do that is by creating beta-lactamase which breaks down the beta-lactam ring in penicillins preventing them from attaching to the bacteria walls. There is a chemical class that can prevent this called beta-lactamase inhibitors that are often coupled with penicillins.
Carbapenems are a class of beta-lactam antibiotics with a broad spectrum of antibacterial activity, and have a structure which renders them highly resistant to beta-lactamases.
The cephalosporins are bactericidal antibiotics that have chemical structures similar to those of penicillins and therefor have the same mechanism of action. Also, due to their similar chemical structure to penicillin, there is a 7-10% potential of cross sensitivity. The cephalosporins are considered to be broad spectrum drugs. Their two main uses are as substitutes for penicillins in cases of allergy or bacterial resistance and in the treatment of certain gram negative infections.
The aminoglycosides are a group of bactericidal antibiotics whose antibacterial spectrum mainly includes gram-negative bacilli. Aminoglycosides have poor oral absorption, therefore if systemic effects are desired they are usually given IV or IM. Aminoglycosides are both nephrotoxic (kidney) and ototoxic (ear).
The tetracyclines (a group of broad-spectrum bacteriostatic antibiotics) are clinically useful in both gram-positive and gram-negative infections.
When ingested, it is usually recommended that tetracyclines should be taken with a full glass of water, either two hours after eating or one hour before eating. This is partly because tetracycline binds easily with magnesium, aluminum, iron, and calcium, which reduces its ability to be completely absorbed by the body. Dairy products or preparations containing iron are not recommended directly after taking the drug.
Side effects from tetracyclines are not always common, but of particular note is possible photosensitive allergic reaction which increases the risk of sunburn under exposure to UV light from the sun or other sources. Tetracyclines are teratogens due to the likelihood of causing teeth discoloration in the fetus as they develop in infancy. For this same reason, tetracyclines are contraindicated for use in children under 12 years of age.
Sulfonamides are a group of synthetic bacteriostatic drugs which are effective against both gram-positive and gram-negative infections. Approximately 3% of people using sulfonamides report side effects, the most common of which are hypersensitivity reactions such as rash and hives, but some patients may have more severe reactions.
Sulfonamides have the potential to crystallize in the kidneys, due to their low solubility. This is a very painful experience, so patients are recommended to take these medication with large amounts of water.
The term macrolide refers to the large chemical ring structure that is characteristic of these antibiotics. These antibiotics inhibit bacterial protein synthesis and can be bacteriostatic or bactericidal. Food effects oral absorption of these drugs, although they frequently cause GI problems which may warrant taking them with food. Macrolides may interfere with some medications that require liver biotransformation such as digoxin, warfarin, and cyclosporine therefore a different antibiotic choice may be desirable if a patient is currently using any of those medications.
The fluoroquinolones, often just called quinolone antibiotics, are synthetic antimicrobial agents that are a broad spectrum bactericidal, especially against gram-negative organisms. A black box warning has been added to all fluoroquinolones involving an increased risk of developing tendinitis and tendon rupture in patients of all ages taking fluoroquinolones for systemic use. This risk is further increased in individuals over 60 years of age, taking corticosteroid drugs, and have received kidney, heart, or lung transplants.
Some common antibiotics are the only drugs in their respective classes. The following listed medications are examples of those. These drugs each have their own side effects and precautions, for example, IV use of vancomycin may cause a reaction known as red man syndrome characterized by flushing and/or rash that affects the face, neck, and upper torso.
An antifungal drug is medication used to treat fungal infections such as athlete's foot, ringworm, candidiasis (thrush), serious systemic infections such as cryptococcal meningitis, and others.
Antifungals work by exploiting differences between mammalian and fungal cells to kill off the fungal organism without dangerous effects on the host. Unlike bacteria, both fungi and humans are eukaryotes. Thus fungal and human cells are similar at the molecular level. This means it is more difficult to find a target for an antifungal drug to attack that does not also exist in the infected organism. Consequently, there are often side-effects to some of these drugs. Many of these agents are hepatotoxic (liver) and liver function and enzymes must be monitored. It is not uncommon for therapy to last for several months.
An amebicide (or amoebicide) is an agent used in the treatment of amoebic infections. Alcohol use should be avoided while taking metronidazole because concurrent use may cause nausea, vomiting, flushing of the skin, tachycardia, and shortness of breath.
Antimalarial drugs are agents used to prevent and cure malaria. Some antimalarial drugs, such as hydroxychloroquine, are also used to treat conditions like rheumatoid arthritis and lupus. One of the most serious side effects is a toxicity in the eye (this primarily occurs with chronic use).
Antiviral drugs are a class of medication used specifically for treating viral infections. Like antibiotics, specific antivirals are used for specific viruses. They are relatively harmless to the host, and therefore can be used to treat infections. They should be distinguished from viricides, which actively deactivate virus particles outside the body.
Most of the antivirals now available are designed to help deal with HIV; herpes viruses, best known for causing cold sores and genital herpes, but actually causing a wide range of diseases; the hepatitis B and C viruses, which can cause liver cancer; and influenza A and B viruses. Researchers are now working to extend the range of antivirals to other families of pathogens.
Antiviral drugs work by inhibiting the virus ether before it enters the cell, stopping it from reproducing, or in some cases preventing it from exiting the cell. However, like antibiotics, viruses may evolve to resist the antiviral drug.
