Pharm Exam 3

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dparks33
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Pharm Exam 3
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2011-04-23 16:43:03
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Pharmacology NSAIDS DMARD Antimicrobials Gout
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Pharmacology Exam #3
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  1. Pharmacological Effects of NSAIDs (6)
    • 1. Analgesia
    • 2. Antipyretic
    • 3. Antiinflammatory
    • 4. GI Irritation
    • 5. Inhibit Platelet Aggregation
    • 6. Cardiovascular & Metabolic
  2. Adverse Effects of NSAIDs (5)
    • 1. Allergy
    • 2. GI Irritation- take with full glass of H2O
    • 3. Poisonings- especially in children
    • 4. Reye's Syndrome
    • 5. Decreased Kidney Function- increases sodium and decreases blood flow to kidney *ELDERLY
  3. NSAID Allergy
    -Types
    -Those at Risk
    • Type 1: Chemical Allergy to salicylates
    • Type 2: Hypersensitivity because it blocks COX1&2 pathway and increases leukotrienes which have allergic reaction properties leading to anaphylaxis
    • Risk: Must have all 3- Aspirin Allergy, Asthma, Nasal Polyps
  4. NSAID DDIs (4)
    • 1. Drugs with added GI irritation- Corticosteroids, Alcohol, NSAIDs
    • 2. Warfarin Anticoagulants (Coumadin)
    • 3. Probenecid (Gout Drug)
    • 4. Low level DDI- Ibuprofen w/ Aspirin
  5. Clinical Uses of NSAIDs (5)
    • 1.Rheumatoid Arthritis-treats sx (pain, inflammation) but doesn't stop the progression of the disease.
    • 2. Analgesia
    • 3. Antipyretic
    • 4. TIA (tranisent ischemic attack)- intermittent stroke like sx without long term damages
    • 5. MI prevention
  6. Aspirin
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Special Notes
    • 1. Non-Steroidal Antiinflammatory Drug
    • 2. RA, Analgesia, Antipyretic, TIA, MI prevention
    • 3. Allergy, GI Irritation, Poisonings (Low doses in children), Reye's Syndrome, Decreased Kidney Function (Elderly)
    • 4. Drugs with additive GI Irritation (Corticosteroids, alcohol, other NSAIDs), Warfarin anticoagulants, Probenicid, Ibuporfen (w/ Low dose aspirin)
    • 5. Has strong Antiplatelet properties which leads to a lot of GI bleeding. Also discontinue use at least a week before any surgery.
  7. Reye's Syndrome
    An adverse effect of NSAIDs affecting children with Chicken pox or the Flu. Take child to ER immediately if sx- vomiting, lethargy, sleepy, violent HA, disorientation, violent. It can lead to death.
  8. Ibuprofen
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Special Notes
    6. Dose
    • 1. Non-steroidal antiinflammatory drug
    • 2. Dysmenorrhea (at onset and for first 3 days), analgesic, antipyretic, inflammation
    • 3. Kidney dysfunction (Elderly and people on diuretics), Na+ retention, Less GI bleeding the ASA
    • 4. Additive GI irritants (corticosteroids, alcohol, NSAIDs), Warfarin anticoagulants, Probenecid, Baby Aspirin
    • 5. Take with foor or milk. Precaution in CHF and HTN due to sodium retention.
    • 6. Analgesic/Antipyretic- 200-400 mg po q4-6h Max 3.2g/day
  9. Dosages
    1.Ibuprofen
    2. Ketorolac
    3. Allopurinol
    4. Cefazolin
    5. Gentamicin
    • 1. 200-400mg po q4-6h Max 3.2g/day
    • 2. 30-60mg IM LD, 15-30mg IV/IM g6h regularly or prn. LIMIT 5 days
    • 3. 300 mg po qday
    • 4. 1-2 g IV q8h
    • 5. 80mg IV q8h
  10. Drugs with precautions in Children/Infants (3)
    • 1. NSAIDs- Reye's syndrome (Flu/Chickenpox pt), Poisonings even with small doses.
    • 2. Tetracyclines -<7
    • 3. Fluoroquinolones (Ciprofloxacin) <16
  11. Drugs with Precautions for the Elderly
    • 1. NSAIDs- Kidney dysfunction and GI Bleeding
    • 2. Ketorolac-start with a low dose
  12. Drugs to Avoid in Pregnancy (7)
    • 1. Naproxen- 3rd trimester could prolong pregnancy/labor
    • 2. Indomethacin- might close patent ductus arteriosus before birth.
    • 3. Leflunomide-must stop 2 years before becomming pregnant (males too) or can take cholestryamine for 11 days.
    • 4. Gentamicin-ototoxicity to fetus
    • 5. Tobramycin- ototoxicity
    • 6. Ciprofloxacin
    • 7. Tetracycline- pregnancy and breast feeding
  13. Naproxen
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Special Notes
    • 1. NSAID
    • 2. Inflammation (more potent than ibuprofen), dysmenorrhea, analgesia.
    • 3. Avoid in pregnancy (3rd trimester prolongs labor), Kidney dysfunction, Na+ retention, GI Irritation (less than ASA)
    • 4. GI Irritants (Coricosteroids, Alcohol, NSAIDs), Warfarin, Probenecid
    • 5. Longer acting than ibuprofen.
  14. Indomethacin
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Special Notes
    • 1. NSAIDs
    • 2. Gouty Attack, IV-Closes patent ductus arteriosus in neonates.
    • 3. More serious than ibuprofen- peptic ulcer, CNS (HA, dizziness), bone marrow depression. Not for use in pregnancy.
    • 4. GI irritants, warfarin, probenecid
    • 5. A last resort NSAID for pain/fever due to serious side effects. Not to be used in pregnancy so patent ductus arteriosus isn't closed before baby is born. Very potent prostglandin inhibitor.
  15. Ketorolac
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Special Notes
    6.Dose
    • 1. NSAID
    • 2. First short term NSAID for Pain management
    • 3. Peptic ulcer and bleeding if used longer than 5 days.
    • 4. GI irritants, Warfarin, Probenecid
    • 5. Start with low dose for elderly. More powerful analgesic, less antiinflammatory effects.
    • 6. 30-60mg IM LD, 15-30mg IV/IM g6h regularly or prn. LIMIT 5 days
  16. Celecoxib
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Special Notes
    • 1. COX-2 Inhibitor
    • 2. Analgesia, Platelet aggregation
    • 3. Abdominal pain, diarrhea, dyspepsia, HA, Allergy (sulfonamides), BLACK BOX- increases risk of MI, CV disease, and stroke because when COX-2 pathway is inhibited COX-1 pathway increases (increases platelet).
    • 4.
    • 5. When to Use a COX-2 Inhibitor- Pts with multiple medical problems; >75, Pts on corticosteroids, Prior GI bleeds. *Better idea to use an NSAID with less COX-1 inhibition for pts with GI problems rather than a COX-2 inhibitor.
  17. Just FYI
  18. Methotrexate
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Special Notes
    • 1. Disease modifying anti-rheumatic drugs (DMARD)
    • 2. For the treatment of RA- Reduces joint damage, increases joint function and integrity. Also used for Cancer and disabling psoriasis
    • 3. Liver damage, myelosuppression, rare pulmonary toxicity, toxicity
    • 4. Leflunomide (Increases liver toxicity)
    • 5. Selected first- low cost, efficacy, low adverse effects. Benefit seen in 1-2 months.
  19. Leflunomide
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Special Notes
    • 1. Disease modifying anti-rheumatic drugs (DMARD)
    • 2. Treatment of RA
    • 3. Diarrhea, rash, reversible alopecia, contraindicated in pregnancy
    • 4. NSAID (Ibuprofen), Cholestyramine, Methotrexate (Increases liver toxicity)
    • 5. Antiproliferative effect on T-Cells. Category X for pregnancy- Males and females must stop taking it if trying to become pregnant- Can take cholestyramine for 11 days.
  20. Etanercept
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Special Notes
    • 1. Biological Response Modifiers (BRM are like DMARDs)
    • 2. Treats RA (strong antiinflammatory effect)
    • 3. Injection site Reaction (erythema, itching, pain, swelling), positive antinuclear bodies, increased infection risk. FDA warning- Risk of fungal infection can lead to death in immunosuppressed individuals.
    • 4.
    • 5. Very expensive and only available injectable, used only when other RA treatment doesn't work. Prep-powder mixed with bacteriostatic H20- gently swirled to avoid foaming. [Acts as a Tumor necrosis factor (TNF) receptor and TNF is main cytokine responsible for inflammation in RA]
  21. Colchicine
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Special Notes
    • 1. Gout Drug
    • 2. Treats gout by decreasing joint inflammation
    • 3. GI-N/V/D, abdominal pain, chronic toxicity.
    • 4.
    • 5. Use only until gout symptoms are relieved or if GI is upset. Injected directly into the joint.
  22. Indomethecin
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Special Notes
    • 1. Gout drugs
    • 2. Treats gout by decreasing inflammation in the joint.
    • 3. Less adverse effects than Colchicine- N/V/D, Abd pain.
    • 4.
    • 5. For short term use only. 1st choice for acute gout attacks.
  23. Allopurinol
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Special Notes
    6. Dose
    • 1. Gout drug
    • 2. Treatment of Gout by decreasing uric acid production
    • 3. Rash, drowsiness, bone marrow depression (sore throat, bleeding), kidney stones.
    • 4. Azathioprine and 6-mercaptopurine (Cancer drugs)- will have to adjust the dose
    • 5. Used with kidney dysfunction because kidney can't remove uric acid effectively. Acute attacks may occur as crystals break up and begin moving out of joints.
    • 6. 300 mg po qday
  24. Probenecid
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Special Notes
    • 1. Gout drugs
    • 2. Treats gout by increasing renal excretion of uric acid (inhibits reabsorption)
    • 3. kidney stones, N/V, anorexia, hematuria, HA.
    • 4. Many- Aspirin, diuretics
    • 5. Need to increase fluid intake and alkalinize the urine. Not for use in impaired kidney function.
  25. Gout
    Risk factors?
    • Uric acid metabolism disorder causing crystals to form in joints.
    • Obesity, Males, Alcoholism, Heredity, Middle Age
  26. Penicillin
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Special Notes: Differences between the different penicillin preparations (G,V, etc)
    • 1. Antibiotic (Penicillins)
    • 2. Mostly Gram + bacteria
    • 3. Allergic reaction (most common drug allergy), contact dermatitis, GI distress.
    • 4.
    • 5. G- original, oral only, must be taken on empty stomach; V(K)- oral not affected by food, no need to be on empty stomach; G(parenteral)- combined with sodium or potassium salts so monitor electrolyte levels.
    • Not effective against penicillinase (beta-lactamase) producing organisms.
  27. Methicillin
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Special Notes
    • 1. Semi-synthetic penicillins
    • 2. IV for Penicillin resistant organisms (Gram +)
    • 3. No need to know
    • 4.
    • 5. There are methicillin resistant organisms now.
  28. Dicloxacillin
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Special Notes
    • 1. Semi-synthetic penicillins
    • 2. Oral treatment for penicillin resistant organisms (Gram +)
    • 3.
    • 4.
    • 5. Acid Resistant too so no need to take on empty stomach. For mild to moderate infections.
  29. Ampicillin
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Special Notes
    6. What's the mixture?
    • 1. Non-penicillinase resistant broad spectrum penicillin
    • 2. Broader spectrum, includes Gram - organisms too
    • 3. Diarrhea
    • 4.
    • 5. Short acting so many doses needed. Usually only used when injectable needed for broad spectrum penicillin.
    • 6. ampicillin/sulbactam- for resistant broad spectrum tx.
  30. Amoxicillin
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Special Notes
    6. Mixture
    • 1. Non-penicillinase resistant broad spectrum penicillin
    • 2. Gram + and -, Oral antibiotic
    • 3. Less GI upset (diarrhea)
    • 4.
    • 5. Longer acting, higher blood levels than ampicillin. Only oral.
    • 6. Amoxicillin/potassium clavulanate for penicillin resistant broad spectrum tx.
  31. Piperacillin
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Special Notes
    6. Mixture
    • 1. Antipseudomonal penicillins
    • 2. Pseudomonal effective peniccillin
    • 3. Antiplatelet, Hypokalemia, CNS- confusion/lethargy
    • 4. Aminoglycosides- incompatible so cannot be mixed and IV must be separated by >1 hour
    • 5.
    • 6. Piperacillin/tazobactam- for penicillin resistant organisms
  32. Cefazolin
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Special Notes
    6. Dose
    • 1.Cephalosporins 1st Generation
    • 2. Antibiotic (Gram + but more Gram - than penicillin); commonly used as prophylaxis before surgery.
    • 3. Allergy (similar to penicillin), pain and sterile abscesses at injection sites, transient disturbances in hepatic, renal, or hematological function.
    • 4.
    • 5. Preferred injectable. Less painful IM injection.
    • 6. 1-2 g IV q9h
  33. Cephalexin
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Special Notes
    • 1. 1st generation Cephalosporins
    • 2. Oral Antibiotic (mostly gram + but some gram - too)
    • 3. Allergy (similar to penicillin), diarrhea, transient disturbances in hepatic, renal, and hematological function.
    • 4.
    • 5. Oral agent
  34. Cefuroxime
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Special Notes
    • 1. 2nd Generation Cephalosporin
    • 2. Gram +/- infection, Reserved for resistant gram - tx.
    • 3. Allergy, pain and abscess at injection site, diarrhea (oral), disturbances in renal, hepatic, hematologic function.
    • 4.
    • 5. Careful of Kidney Dysfunction
  35. Ceftizoxime
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Special Notes
    • 1. 3rd Generation Cephalosporins
    • 2. Mostly gram - antibiotic, usually reserved for multiple drug resistant HAI strains
    • 3. Kidney Dysfunction, allergy, pain and abscess at injection site, hematologic and hepatic disturbances.
    • 4.
    • 5. Long duration of action. Careful of Kidney dysfunction.
  36. Reasons to avoid 2nd and 3rd generation cephalosporins (2)
    • 1. Platelet dysfunction
    • 2. Disulfiram-like reaction - can't have alcohol or you'll get very sick.
  37. Erythromycin
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Special Notes
    6. Mixtures
    • 1. Macrolides/Lincosamides
    • 2. Penicillin alternative for allergy
    • 3. GI
    • 4.
    • 5. Can be oral or injectable. Both require special preparation.
    • 6. Oral- acid sensitive so special salt forms used so monitor electrolytes. Injectable- lactobionate is pH sensitive so must be mixed with Sterile H20 without preservative and infused with NS or Buffer d5W
  38. Clindamycin
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Special Notes
    • 1. Macrolide/Lincosamides
    • 2. Penicillin alternative, also AIDS related infx
    • 3. Diarrhea, pseudomembranous colitis (bloody stools), causes neuromuscular blockade
    • 4.
    • 5. pseudomembranous colitis is caused by a supra infection when clindamycin knocks out normal flora in GI.
  39. Vancomycin
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Special Notes
    • 1. Macrolide/Lincosamides
    • 2. For methicillin resistant staph infections (IV)
    • 3. Ototoxicity, nephrotoxicity, skin irritation-pain, thromboblitis, tachycardia (if given too fast), Red Man syndrome (if infused too quickly)
    • 4.
    • 5. Infuse slowly- 1-2 hours or may lead to Red Man syndrome- Low BP bright red face and chest. Must adjust dose in kidney dysfuntion
  40. Gentamicin
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Special Notes
    6. Dose
    • 1. Aminoglycosides
    • 2. Very broad spectrum antibiotic
    • 3. Ototoxicity (vestibular function-balance), nephrotoxicity, neuromuscular blockade (careful of myasthenia gravis), Pregnancy precaution
    • 4. Piperacillin (incompatible to mix)
    • 5. Must take peak-to find therapeutic blood levels, and troughs- to make sure there is no build up (toxicity). Hearing damage to fetus. Infuse slowly 30-60 min to avoid neuromuscular blockade. Dose must be adjusted for kidney dysfunction.
    • 6. 80 mg IV q8h
  41. Tobramycin
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Special Notes
    • 1. Aminoglycosides
    • 2. Broad spectrum antibiotic, for Gentamicin resistant organisms.
    • 3. Pregnancy precaution, ototoxicity, nephrotoxicity, neuromuscular blockade (infuse slowly 30-60min?)
    • 4. Piperacillin
    • 5. Adjust dose in kidney dysfunction
  42. Tetracycline
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Special Notes
    • 1. Tetracyclines
    • 2. Broad spectrum against a wide range of microorganisms.
    • 3. Photosensitivity, suprainfection (Secondary Fungal), GI upset, Allergy, Precaution in Pregnancy and those under 7 yo.
    • 4. Antacids and Iron
    • 5. Absorption inhibited by food.
  43. Doxycycline
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Special Notes
    • 1. Tetracycline
    • 2. Broad spectrum antibiotic
    • 3. Photosensitivity, suprainfection (Fungal), Pregnancy and < 7yo.
    • 4. Antacids and Iron
    • 5. Ok with food. Longer half life, Less excretion by kidneys so good choice for Kidney Dysfunction
  44. Metronidazole
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Special Notes
    • 1. Antibiotic
    • 2. Trichomonal Vaginitis treatment
    • 3. Dry mouth, metallic taste, nausea, disulfiram reaction (no alcohol), metabolites carcinogenic in rats (prop 65)
    • 4.
    • 5. Must tell sexual partner to take the drug too
    • 5.
  45. Ciprofloxacin
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Special Notes
    • 1. Fluoroquinolones
    • 2. Reserved for complicated UTI
    • 3. BLACK BOX: risk of tendon rupture or tendonitis especially >60, those on corticosteroids, and transplant recipients. Pregnancy and Breast feeding precaution, careful <16 yo.
    • 4. Theophylline (and Caffeine)-bronchodilator, Aluminum and Magnesium antacids, Iron Vitamins and Zinc
    • 5. Take with a lot of Fluids
  46. Sulfisoxazole
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Special Notes
    • 1. Sulfonamides
    • 2. Topical burns, eye and vaginal infections, Sterilize GI pre-surgery.
    • 3. GI and UT disturbances, Hematologic effects, Common allergy
    • 4.
    • 5. Short acting, Drink plenty of fluids 3L/day
  47. Bactrim/Septra
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Special Notes
    • 1.Sulfonamides. Sulfamethoxazole and Trimethoprim combo.
    • 2. UTI, otitis media, PCJ infections
    • 3. GI/UT, hematologic, allergy
    • 4.
    • 5. Dose usually based on trimethoprim component. Drink plenty of Fluids (3L/day)
  48. Phenazopyridine
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Special Notes
    • 1-2. Urinary tract analgesic
    • 3. Turns urine orange, also will stain soft contact lenses
    • 4.
    • 5. Sx of UTI occur in 1st 3 days so this drug is used early on.
  49. Initial Phase treatment of TB
    INH, RIF, PZA (EMB if needed) -for 2 months
  50. Continuation phase treatment of TB
    INH and RIF daily for 4 months
  51. Treatment of Resistant TB
    • Initial phase 2 months-INH, RIF, PZA and EMB
    • Continuation phase 6 months RIF, PZA, EMB
    • Can also uses some Fluoroquinolones
  52. Isonizaid
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Special Notes
    • 1. INH Tb Treatment
    • 2. Can be used for prophylaxis tx.
    • 3. HA, Vertigo, Peripheral Neuritis (Vit B6 Deficiency in alcoholics), SLE, Hepatits (Rare but serious, >35)
    • 4. HIV drugs.
    • 5. If HIV + extend treatment from 6 mo to a year. Monitor liver function tests.
  53. Rifampin
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Special Notes
    • 1. RIF Tb Drug
    • 2. TB treatment, also gram -/+ antibacterial
    • 3. GI upset, hepatotoxicity, red color
    • 4. HIV drugs, Food
    • 5. Take on empty stomach
  54. Ethambutol
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Special Notes
    • 1. EMB Tb drug
    • 2. For INH resistant Tb
    • 3. Optic neuritis, hyperuricemia, pruritis
    • 4. HIV drugs, Allopurinol
    • 5. Monitor vision
  55. Pyrazinamide
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Special Notes
    • 1. PZA Tb Treatment
    • 2. Usually only taken for 2 months of Tb treatment
    • 3. Hyperuricemia, muscle aching, hepatotoxicity.
    • 4. Allopurinol, AIDs drugs.
    • 5. Contraindications in Liver Disease and Gout. Do not exceed 2g/day to avoid liver toxicity.
  56. Amphotericin B desoxycholate
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Special Notes
    • 1. Antifungal
    • 2. IV for life threatening systemic fungal infections
    • 3. Flu-like, kidney damage
    • 4.
    • 5. Not for use in renal impairment... must switch to amphotericin lipid base.
  57. Ketoconazole
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Special Notes
    • 1. Antifungal
    • 2. Systemic fungal infections
    • 3. Flu-like sx, Gynecomastia (man boobs), hepatotoxicity
    • 4. Antacids, H2 antagonists, proton pump inhibitors - all because it needs an acidic environment to work.
    • 5. oral
  58. Nystatin
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Special Notes
    • 1. Antifungal
    • 2. Candida infections of skin, vag, and Intestine, and Thrush
    • 3. N/V/D
  59. Acyclovir
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Special Notes
    • 1. Antiviral
    • 2. Topical-herpes genitalis, IV-systemic viral infx (usually in immunocompromised), oral- Herpes zoster(shingles)
    • 3. IV: Kidney damage, Oral NVD, dizziness, HA
    • 4.
    • 5. Avoid Kidney damage by increasing hydration and infuse over 1 hour.
  60. Herpes Zoster(Shingles)
    • Shingles is a flare up of a latent chicken pox virus.
    • Painful rash on nerve track
    • Can lead to postherpetic neuralgia- extrem pain after shingles.
  61. Drugs with Kidney Effects (8)
    • 1. Amphotericin B Desoxycholate- cannot be used in kidney dysfunction must use amphotericin lipid base
    • 2. Vancomycin-dose must be adjusted
    • 3. Tetracycline
    • 4. 2nd and 3rd gen cephalosporins
    • 5. Gentamicin
    • 6. NSAIDs- decreases function
    • 7. Probenecid- isn't effective
    • 8. Tobramicin

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