Pharmacology Review of 47, 48, 49
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___ is the primary mineral responsible for bone formation and for maintaining bone health throughout the life span.
This major mineral constitutes about 2% of our body weight and is critical to proper functioning of the nervous system, muscular, and cardiovascular systems.
To maintain homeostasis, Calcium balance in the body is regulated by _____, ______, and ______.
parathyroid hormone, calcitonin, vitamin D
True or False: Hypocalcemia is a potentially serious disease.
False: it is not a disease, but a sign of underlying pathology and the cause must be determined (it has various causes).
How is hypocalcemia treated?
- Unless the hypocalcemia is life threatening, adjustments in diet should be attempted prior to initializing therapy, with calcium supplements.
- If a change in diet is not practical or had not proved adequate for reversing the hypocalcemia, effective and inexpensive calcium supplements are readily available over the counter
- Severe hypocalcemia requires the intravenous administration of calcium salts.
Long term use of _____ is a very common cause of hypocalcemia as well as ______.
What are the signs and symptoms of hypocalcemia?
- Nerve and muscle excitability
- Assessment may reveal muscle twitching, tremor, or abdominal cramping with hyperactive bowel sounds.
____ is a metabolic bone disease characterized by softening of the bones due to demineralization. What is used to treat the condition?
- In extreme cases, surgical correction of disfigured limbs may be necessary
- Drug therapy for children and adults consists of calcium supplements and vitamin D ( a fat soluble vitamin)
Excess vitamin D will cause calcium to do what?
Leave bones and enter the blood.
____ is the most common metabolic bone disorder. It is usually asymptomatic until the bones become brittle enough to fracture or collapse.
What drug therapies are used for osteoporosis (7, know at least 3) ?
- Calcium and Vitamin D therapy
- Estrogen Replacement Therapy (ERT)
- Selective Estrogen Receptor Modulators
- Slow release sodium flouride
What is the most common drug for treating osteoporosis? How do they work?
- They are structural analogs of pyrophosphate, a natural substance that inhibits the breakdown of bone.
- They inhibit bone resorption by suppressing osteoclast activity, thus increasing bone density and reducing the incidence of fractures by about 50%
These drug inhibit bone resorption by suppressing osteoclast activity, thus increasing bone density and reducing the incidence of fractures by about____%.
____ are a relatively new class of drugs that are used in the treatment and prevention of osteoporosis. When they bind to estrogen receptors, they may either activate them or inhibit them, depending on the specific drug and the tissue involved. Technically speaking, then, these drugs can act as estrogen _____ or ______.
- Selective Estrogen Receptor Modulators (SERMs)
- Agonists or Antagonists.
____ is a hormone secrete by the thyroid gland when serum calcium is elevated. It acts in direct opposition to what two susbstances?
- PTH and Vitamin D
As a drug, ______ is approved for the treatment of osteoporosis in women who are more than 5 years postmenopausal. It increases bone density and reduces the risk of vertebral fractures.
____ is a progressivem degenerative joint disease that is caused by the breakdown of articular cartilage. It is the most common type of arthritis.
This most common type of arthritis usually affects weight bearing joints.
What are the goals of pharmacotherapy for osteoarthritis (OA)?
Reduction of pain and inflammation
What is the initial treatment of choice for osteoarthritis? What is used if this does not work?
- The initial treatment of choice is acetaminophen because it is inexpensive and relatively safe.
- For patients who have persistent pain, NSAIDs may be used.
True or False: Tramadol (Ultram) is a nonscheduled opoid that has become a popular drug to relieve pain experienced by osteoarthritic patients.
Opoids such as ______ should not be used in combination with acetaminphen in the treatment of osteoarthritis. Why?
- They can cause severe pain when taken in combination.
Many patients with Osteoarthritis (OA) now use OTC topical creams, sprays, patches, gels, or ointments. What are common ingredients in these?
This is a relatively new treatment for osteoarthritis that involves replacing or supplementing the body's natural hyalauronic acid that deteriorated because of the inflammation of osteoarthritis.
Injection of sodium hyaluronate (Hyalgan)
_____ is a chronic, progressive disease that is characterized by disfigurement and inflammation of multiple joints. It occurs at an earlier age and had an autoimmune etiology.
Pharmacotherapy for the relief of pain associated with RA is begun with ____, because these agents relieve both pain and inflammation. They are usually given in doses ____ than that required for osteoarthritic patients.
True or False: Aspirin is not recommended for long term therapy of either osteoarthritis or rheumatoid arthritis.
- The high doses needed for pain relief in these patients increase the risk for GI bleeding, and the antiplatelet effects make it specifically contraindicated in therapy for RA.
Because of their potent anti-inflammatory action, ______ may be used for RA flare ups, but are not used for long term therapy because of their adverse effects.
The progression of ____ arthritis can be modified with drug therapy. What is the name of the class of drugs that can accomplish this?
- Disease-Modifying Anti-Rheumatic Drugs (DMARDs)
What is the main side effect of Disease-Modifying Antirheumatic Drugs?
- Opportunistic infections,
- ie. TB
- Hepatitis B reactivation
- Invasive Fungal infections
____ is a form of acute arthritis caused by the accumulation of uric acid (urate) crystals in the joints and other body tissues, causing inflammation.
What can be the biological mechanisms responsible for forming the urate crystals that cause Gout?
- Increased metabolism of nucleic acids
- Reduced excretion of uric acid by the kidneys
What drugs can cause Gout?
- Thiazide diuretics
____ are the drugs of choice for treating the pain and inflammation of acute attacks of Gout: however, _____ may be used to treat exacerbations of acute gout, particularly when the symptoms are in a single joint and the medication can be delivered intra-articularly.
Prophylactic therapy with special medications may be used for patients who suffer frequent and acute gout attacks. _____ and _____ are the drug classes used in the prophylaxis of gout. Explain the mechanisms of each.
Uric Acid inhibitors: Reduces the accumulation of uric acid in the blood or uric acid crystals in the joints.
Antigout medications: increase the excretion of uric acid by blocking its reabsorption in the kidney.
What should any plan for gout management, particularly management of frequent gout, include?
- Dietary changes
- Avoidance of Drugs that Worsen the Condition
- Treatment with antigout medications
- Avoidance of high purine foods such as meat, legumes, alcohol, and oatmeal ---> nucleic acids when metabolized.
What are the three layers of the skin?
- The epidermis
- The dermis
- The subcutaneous tissue
The ____ is the visible, outermost layer that constitutes about 5% of the skin depth. It contains the_____: an effective barrier that repels bacteria and foreign matter.
How many layers constitute this layer?
- Stratum corneum, which contains the protein keratin
four or five depending on its thickness
The ____ is the middle layer of skin that accounts for about 95% of the entire skin thickness. Most sensory nerves, oil glands, and sweat glands are located here, and it provides the foundation or accessory structures like skin, hair, and nails.
Beneath the dermis is the ______, also called the hypodermis. It consists mainly of adipose tissue which cushions, insulates, and provides a source of energy for the body.
Common skin parasites include _____ and ______.
____ are drugs that kill mites.
Pedicullicides are drugs that kill ______.
____ are a class of drugs that is closely related to vitamin A that are used in the treatment of inflammatory skin conditions, dermatological malignancies, and acne.
The topical formations of_____ are often the drugs of choice for mild to moderate acne, particularly in the presence of inflammatory cysts.
____ are sometimes used in combination with acne medication in order to lessen the severe redness and inflammation associated with the disorder.
____ are used as part of the regimen for acne along with other medications, particularly when the acne is inflammatory and results in cysts and pustules.
____ is an inflammatory skin disorder of unknown etiology with lesions affecting mainly the face. Unlike acne, it is a progressive disorder with an onset between 30 and 50 years of age.
____ is characterized by small papules or inflammatory bumps without pus that swell, thicken and become painful. With time, the redness becomes more permanent, and lesions resembling acne appear.
The soft tissues of the nose may thicken, giveign the nose a reddened, bullous, irregular swelling called ______ in patients affected by what skin condition.
_____ is a general term that refers to superficial inflammatory disorders of the skin. What do the general symptoms of this disorder include?
- Local redness
- Excoriation (intense scratching may lead to this)
What are the three most common types of dermatitis that respond to topical pharmacotherapy?
- atopic (eczema)
- sebhorric (also a form of eczema)
Pharmacotherapy of dermatitis is symptomatic and involves the use of what forms of medication and what agents?
- Topical lotions and ointments to control itching and flaking
- Antihistamines to control inflammation and reduce itching
- Analgesics or topical anesthetics for pain relief
- Topical corticosteroids
True or False: Atopic dermatitis can be cured by medications.
False. It can be controlled, but it cannot be cured.
_____ are the most effective treatment for controlling the inflammation and itching of dermatitis.
Patients with persistent atopic dermatitis who are not responsive to corticosteroids may benefit from what drug class?
_____ is characterized by red, raised patches of skin covered with flaky, thick silver scales called plaques.
What is the reason for the appearance of plaques in psoriasis? What is the disease process involving the plaques?
- An extremely fast skin turnover rate, with skin cells reaching the surface in 4 to 7 days instead of the usual 14.
- Plaques are ultimately shed from the surface while the underlying skin becomes inflamed and irritated.
What drugs can act as triggers for flare ups in patients afflicted with psoriasis?
- ACE inhibitors
- Beta Blockers
_____ are the primary, initial treatment for psoriasis.
What two drug classes are used to treat psoriasis?
- Topical corticosteroids
- Topical Immunomodulators
These drugs provide the same benefits as topical corticosteroids to psoriasis patients, but exhibit a lower incidence of adverse effects.
Topical Immunomodulators (TIMs)
Patients with severe psoriasis resistant to topical pharmacotherapy may require_______
What is the most often prescribed systemic drug for psoriasis?
What are the systemic signs and symptoms of sun burn? Why can a sun burn produce these effects?
- Intense Pain
A sunburn produces these symptoms because the local skin damage releases toxins that can produce systemic effects.
The best treatment for sunburn is ________.
Chemical sunscreens contain_____ for protection against UVA.
_____ sunscreens absorb the spectrum of UV light that is responsible for most sunburns, while ______ sunscreens reflect or scatter light to prevent the penetration of both UVA and UVB rays.
What does treatment for sunburn consist of?
Adressing symptoms with soothing lotions, rest, prevention of dehydration, and topical anesthetic agents.
In what cases of sunburn might oral analgesics be required?
_____ is an eye disease caused by damage to the optic nerve that results in gradual loss of vision, possibly advancing to blindness. _______ IOP (_______) usually accompanies this disorder.
- Intraocular Pressure
_____ occurs when the intraocular pressure becomes so high that it causes damage to the optic nerve.
The median IOP for the general population is ______. An IOP consistently above _____ is considered abnormal and at risk for what disease?
- 15-16 mmHG
- 21 mmHG
True or False: An IOP above 30 mmHg requires immediate treatment because it is associated with permanent vision changes.
What is the usual cause of the increased intraocular pressure that causes glaucoma?
- Glaucoma usually occurs as a primary condition without an identifiable cause.
- It happens subsequent to an increase in ocular pressure resulting from a buildup of aqueous humor in the anterior cavity.
What are the two types of (primary) Glaucoma?
- Closed Angle glaucoma
- Open Angle glaucoma
The build-up of aqueous humor in the _____ that occurs in the disease process of glaucoma can be attributed to what two causes?
- Anterior cavity
- Excessive production of aqueous humor
- Blockage of the outflow of aqueous humor
____ accounts for 5% of all primary glaucoma. It is unilateral and may be caused by stress, injury, or medications.
Closed Angle Glaucoma
What type of glaucoma is being described below?
Pressure inside the anterior chamber increases suddenly because the iris is being pushed over the area where the aqueous humor normally drains.
The displacement of the Iris is die in part to the dilation of the pupil or the accommodation of the lens, causing the angle between the posterior cornea and the anterior iris to narrow.
Closed Angle Glauoma
What angle is affected in closed angle glaucoma?
the angle between the posterior cornea and the anterior iris
True or False: Once the outflow of aqueous humor is totally closed off, closed-angle glaucoma is a medical emergency.
____ is the most common type of glaucoma, accounting for more than 90% of cases.
Open Angle Glaucoma
The cause of ______ glaucoma is not known, and many patients are asymptomatic.
______ glaucoma is usually bilateral, while _____ glaucoma is usually unilateral.
Why is open angle glaucoma called "open angle"?
The iris does not cover the trabecular meshwork: it remains open.
What type of glaucoma will cause permanent blindness if not treated immediately?
Closed Angle Glaucoma
What are the four drug classes used to treat glaucoma?
- Autonomic Drugs
- Carbonic Anhydrase inhibitors
- Osmotic diuretics
Drugs for glaucoma work by which two mechanisms?
- Increasing the outflow of aqueous humor at the canal of Schlemm
- Decreasing the formation of aqueous humor at the ciliary body
Some drugs used as treatment for glaucoma are autonomic agents. List the specific drug types that may be used.
- Beta blockers
- Nonselective sympathomimetics
- Alpha2 Adrenergic agonists
- Cholinergic agonists
_____ are a more recent therapy for glaucoma, and one of the most effective. They are often the drugs of choice because of their long duration of action and limited side effects.
_____ decrease intraocular pressure by enhancing the outflow of the aqueous humor.
Why are autonomic drugs effective in treating glaucoma?
Several structures within the eye receive signals from the sympathetic and parasympathetic divisions of the autonomic nervous system.
These autonomic drugs were the drugs of choice for treating open angle glaucoma before the discovery of the prostaglandin analogs.
_____ and ____ treat open angle glaucoma by decreasing the production of aqueous humor by the ciliary body.
- Beta blockers
- Alpha2-Adrenergic Agonists
____ activate cholinergic receptors in the eye and produce constriction of the pupil (miosis) and contraction of the ciliary muscle, pilling open the trabecular meshwork to allow greater outflow of the aqueous humor in glaucoma patients.
Because of their greater toxicity and more frequent dosing regiment, ______ are normally used only in patients with open angle glaucoma who do not respond to other agents.
_____ activate the sympathetic nervous system to produce pupil dilation (mydriasis), which increases the outflow of aqueous humor in glaucoma patients.
____ can be administered topically or systemically to reduce IOP in patients with open angle glaucoma They act by decreasing the production of the aqueous humor.
Carbonic Anhydrase Inhibitors
Why should serum electrolytes of patients on oral carbonic anhydrase inhibitors be monitored?
Oral formulations are diuretics
____ are occasionally used preoperatively and postoperatively with ocular surgery or as an emergency treatment for closed angle glaucoma attacks.
Because these drugs have the ability to quickly reduce plasma volume, they are effective in reducing the formation of aqueous humor.
Which drugs used to treat glaucoma do so by decreasing the production of aqueous humor by the ciliary bodies?
- Osmotic Diuretics
- Carbonic Anhydrase Inhibitors
- Alpha2 Adrenergic Agonists
- Beta Blockers
These drugs used in the treatment of glaucoma work by increasing the outflow of the aqueous humor
- Cholinergic Agonists
- Nonselective Sympathomimetics
What drug class is used to dilate the pupil?
- Mydriatic drugs
- Cycloplegic drugs both dilate the pupil and paraluze the ciliary muscle to prevent the lens from moving during assessment.
_____ drugs are used to dilate the pupil and paralyze the ciliary muscle during eye examinations.
____ drugs dilate the pupil to allow better assessment of the retinal structures.
The basic treatment for ear conditions is topical preparations in the form of ______.
Ear drops; otic preparations.
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