NR565 / NR 565 Final Exam (Latest 2023/2024 Update):Advanced Pharmacology Fundamentals, Study Guides, Projects, Research of Nursing

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NR565 / NR 565 Final Exam (Latest 2023/2024 Update): Advanced Pharmacology Fundamentals NR 565 Final Exam which antacids have the highest absolute neutrophil count (ANC)? - sodium bicarbonate and calcium carbonate What do calcium containing antacids needs for absorption? - vitamin D Antacid Indications - hyperacidity, PUD, GERD, Calcium deficiency, Chronic Renal failure, osteoporosis prevention What is the 1st line therapy for GERD? - H2 blockers and PPIs Antacid ADRs - Mg-diarrhea aluminum & Ca=constipation Antacids: Drug Interactions - Adsorption of other drugs to antacids: Reduces the ability of the other drug to be absorbed into the body=separate administration by 2 hours antacid patient education - symptoms > than 2 weeks, extreme pain, cramping, or blood in stool=call provider lifestyle changed to prevent GERD symptoms - stop smoking increase HOB while sleeping no spicy food, no alcohol, no fatty foods, no chocolate, no caffeine Antidiarrheal classes - opiates absorbents anticholinergics Crofelemer Absorbent antidiarrheals drugs - Kaolin pectin Bismuth subsalicylate (Pepto-Bismol) ; use with each loose stool opiate antidiarrheals drugs - Diphenoxylate with atropine (Lomotil) Diphenoxin with atropine (Motofen) Loperamide (immodium) anticholinergic antidiarrheals drugs - atropine propantheline what causes most diarrhea? - infection, food or drug ingestions, or inflammatory bowel disease polyethlyene glycol electrolyte solution polyethlyene glycol (PEG) 3350; draw water into intestinal lumen Bulk producing laxative - Psyllium methyl cellulose polycarbophil; mixes with water in intestine; slow response, long-term; older adults Lubricant laxatives - mineral oil; soften stool, lubricates intestine surfactant laxative - docusate compounds (Colace); reduce surface tension on the oil water interface on the stool & facilitate a mixture of fat & water into the stool hyperosmolar laxative - glycerine laculose; draws water into intestines Chloride channel activators drugs - lubiprostone (Amitiza); soften stools and increases GI motility; choric idiopathic constipation, IBS, opioid induced constipation Opioid receptor antagonists’ drugs - methylnaltrexone; antagonist in the mu-receptor in the GI track; opioid induced constipation laxative 1st line therapy - stimulants Laxatives are contraindicated in - N/v undiagnosed abd pain bowel obstruction Renal dysfunction (Mg hydroxide) laxative precautions - abuse and dependency cathartic colon=ulcerative colitis tartrazine sensitivity=allergic reactions=asthma Cytoprotective agents - sucralfate (Carafate) misprostol (Cytotec); tx Peptic ulcers caused by NSAID use Clinical Pearl for polyethylene glycol electrolyte solution - salty taste; place on ice in Basin; drink 240 ml/10 mins; tic tac or hard candy reduces salty taste Sucralfate (Carafate) - Adheres to injured gastric ulcers upon contact with gastric acids; . Used for gastric and duodenal ulcers and GERD. Administer on an empty stomach at least one hour before meals and at HS and do not administer within 30 minutes of antacids.; use for 8 weeks Misprostol (Cytotec) - inhibits gastric secretion, mucosal protection; analog of prostaglandin E1; prophylaxis for duodenal ulcers due to NSAIDS or for those that must use NSAIDS; only take during NSAID therapy!; take with food Cytoprotective Agents Side Effects - Carafate=constipation misoprostol=diarrhea, menstrual problems Misoprostol precautions - pregnancy category X; Caution with renal impairment; antiemetic classes - Phenothaizine, Anticholinergics, Antihistamines, -5-HT3 Receptor Blockers, Cannaboids, P/neurokinin 1 (NK1) receptor antagonists, trimethobenzamide Antihistamines antiemetics - anticholinergic, histamine-blocking; Dramamine, Benadryl, Vistaril, Antivert Phenothiazines antiemetics - block dopamine receptors in chemoreceptor trigger zone; not for children; Compazine, perphenazine, Phenergan Cannaboids antiemetics - for N/V associated with cancer & appetite stimulant: dronabinol (Marinol) 5- HT3 receptor antagonist antiemetics - ondansetron (Zofran) palonosteron (Aloxi) H2 receptor antagonists’ precautions/contraindications - caution in: renal impairment-reduce dose for renal dysfunction; no Zantac or Pepcid for children; axid can causes hepatocellular injury H2 receptor antagonists ADR - gynecomastia, impotence, (cimetadine=worst effects), confusion, agitation, depression, disorientation, blood dyscrasias H2 receptor antagonists drug inteactions - cimetidine and CYP 1A2, 2C9, & 2D6 H2 receptor antagonists monitoring - liver function with high doses or long-term use H2 receptor antagonists patient education - take with meals, separate antacids by 30 min-1hr, smoking decreases absorption, alcohol increases gastric irritation, don't double the dose, no Carafate within 2 hours Prokinetic drugs - Metoclopramide (Reglan) prokinetic MOA - stimulate motility of GI tract without stimulating gastric, biliary or pancreatic secretions black box warning for metoclopramide (Reglan) - increased risk for tardive dyskinesia Metoclopramide (Reglan) precaution/contraindications - contraindicated: GI bleed, mechanical obstruction, new GI sx, perforation Caution: in patient with depression=increases SI Metoclopramide (Reglan) ADR - tardive dyskinesia, depression, dizziness, diarrhea, hypoglycemia (diabetics) Metoclopramide (Reglan) drug interactions - increase CNS depression with other CNS depressant drugs, increased risk for EPs with other drugs that cause EPs, anticholinergics reverse action of Reglan Proton Pump Inhibitors (PPIs) MOA - antisecretory; inhibit H+/K+/ATpase enzyme system secretory surface or parietal cell; suppress gastric acid secretion up to 72 hours Proton Pump Inhibitors (PPIs) indications - hyperacidity, duodenal & gastric ulcers, erosive gastritis, Zollinger-Ellison syndrome, part of regimen for PUD, GERD Proton Pump Inhibitors (PPIs) - omeprazole (Prilosec), esomeprazole (Nexium), pantoprazole (Protonix), lansoprazole (Prevacid), dexlansoprazole (Dexilant), rabeprazole (Aciphex) PPI Precautions/Contraindications - caution in: hepatic dysfunction, & elderly contraindicated: protonix & rabeprazole in children <12 PPI ADRs - nutrient deficiencies: decreased iron, B12, & Ca+ (long-term use, increases risk for osteoporosis and fractures, increased risk for c-diff, salmonella, and campy, increases risk for PNA (short-term), ? causes gastric cancer PPI drug interactions - CYP 450 enzymes, decreased effects of certain antivirals, decreases absorption of ketoconazole, ampicillin, digoxin, and iron salts, monitor INR with coumadin and PPIs PPI black box warning - Plavix and omeprazole: decreases the active metabolite of Plavix by 46%= decreased effectiveness PPI monitoring - patients on PPI for ulcer= test for H. pylori, stop PPI therapy x 2 weeks for H. pylori breath test or stool test. GERD management - 1. Non-pharm measures - Elevate head of bed - Avoid alcohol, caffeine, spices, peppermint, etc - Stop smoking - Weight reduction if obese 2. Antacids PRN 3. H2 blockers ("-tidines") in high doses at night or divided BID dosing 4. PPIs ("-zoles") if H2 blockers are ineffective 5. GI/surgical consult PRN PPI therapy for mod to severe GERD - PPI daily x 8 weeks, 30-60 mins before breakfast; tailored to symptom relief; if no relief after 3 months=refer to GI specialist; Bacteriostatic drugs - clindamycin macrolides sulfonamides tetracyclines Bactericidal drugs - ahminoglycosides beta-lactums fluroquinolones Metronidazole Streptogramins vancomycin anti-microbial resistance - 1.) not knowing if the pt had recent use of antibiotics 2.) provider overuse of broad=spectrum antibiotics 3.) not performing susceptibility testing 4.) Age younger than 2 years or older than 65 years 5.) Daycare center attendance 6.) Exposure to young children 7.) Multiple medical co-morbidities 8.) Immunosuppression subclasses of Beta-lactams PCNS - natural PCNS aminopenicillins anti-staphylococcal PCNs extended Spectrum PCNs Pharmacodynamics of Beta-lactam PCNs - inhibit biosynthesis of bacterial wall (beta-lactam ring) 1st line therapy for Strep pharyngitis. - penicillin V 1st line therapy for all bites - Amoxicillin/Clavulanate (Augmentin) Natural PCN's, Drugs - Penicillin V potassium (ledercillin) Penicillin G sodium (PCN G-Na) Penicillin G procaine (Duracillin) Penicillin G benzathine (Permapen) Penicillin G potassium (Pfizerpen) Natural PCNs active against - aerobic gram (+) organisms Aminopenicillins active against - Gram (-) organisms Aminopenicillins Drugs - Amoxicillin Ampicillin Combinations: Amoxicillin-clavulanate (Augmentin) 1st lines therapy for acute otitis media (AOM) & sinusitis - Amoxicillin When aminopenicillins are combined with beta-lactamase inhibitors - their spectrum in broadened beta-lactamase inhibitors that can be combined with aminopenicillins - clavulanate, sulbactam, & tazobactam Penicillinase-resistant penicillin’s drugs - Nafcillin Oxacillin Cloxacillin Dicloxacillin Methicillin Penicillinase-resistant penicillin’s active against - Streptococcus, MSSA, some coagulase-negative staphylococci, peptostreptococcus Anti-pseudomonal penicillin drugs - piperacillin ticarcillin combination: piperacillin/taxobactam ticarcillin/clavulanate Anti-pseudomonal penicillins active against - gram (-) organisms 1st generation cephalosporins drugs - Cephradine (Anspor) Cefazolin (ancef) Cefadroxil (Duricef) Cephalexin (keflex) fluoroquinolones active against - Gram (-) organisms Pharmacodynamics of fluoroquinolines - Interferes with DNA synthesis leading to inability to divide and ultimately, cell death Fluoroquinolones indications - PNA sinusitis UTI proctitis bronchitis skin, joint infections Travelers diarrhea (!st line therapy) black box warning for fluoroquinolones - tendon rupture macrolide drugs - erythromycin clarithromycin dirithromycin azithromycin telithromycin Pharmacodynamics of macrolides - Interferes with steps involves in protein synthesis thereby rendering cell division non- functional macrolides are active against - gram (+) organisms & gram (-) organisms Macrolide indications - CAP (DOC) legionella PNA (DOC) pertussis chronic bronchitis chlamydia H. pylori Group A Strep mycobacterium avium complex endocarditis prophylaxis Macrolide drug interactions - CYP450 & 3A4 inhibitors statins theophylline colchicine carbamazepine sulfonamide drugs - sulfasalazine mafenide silver sulfasalazine combinations: trimethoprim/sulamethoxazole (Bactrim) sulfonamide drugs active against - Grams (+) & Gram (-) sulfonamide indications - Ulcerative colitis ocular infections burn infections toxoplasmosis chronic bacterial proctitis prevention of UTIs in women Pharmacodynamics of sulfonamides - Inhibits invading organisms from using substances essential to their growth and development; block folic acid synthesis Trimethoprim mechanism of action - inhibits DNA synthesis Trimethoprim active against - gram (-) & gram (+) organisms Nitrofurantoin mechanism of action - inhibits acetyl co-enzymes Nitrofurantoin active against - gram (-) & gram (+) organisms sulfonamide drug interactions - sulfonylureas methotrexate cyclosporine hydantoins probenecid thiazide diuretics warfarin what causes ophthalmia neonatorum - chlamydia 1st line therapy for uncomplicated UTI - trimethoprim/sulfamethoxazole (Bactrim) most common UTI organisms - E.coli Klebsiella Proteus (men) Pseudomonas Enterobacter Staphylococcus saprophyticus 1st line therapy for uncomplicated UTI in adult women - nitrofurantoin Characteristics of Complicated UTI - symptoms > 7 days Rigors flank pain DM, pregnancy, immunocompromised, renal calculi recent d/c from hospital for nursing home 3 or > UTI in past year failed antibiotics within past 4 months resident at ECF Recurrent UTI prevention - Bactrim single strength daily at bedtime x 6 months indications for referral to Urologist - neonates, children <5 gross hematuria persistent microscopic hematuria symptoms of obstruction persistent UTIs infection with urea-splitting bacteria symptomatic pregnant patients high fever dehydrated septic Antimycobacterial drugs - isoniazid (INH) Rifampin Ethambutol Pyrazinamide Streptomycin antimycobacterial mechanism of action - interferes with lipid &Nucleic acid biosynthesis in growing organisms active TB first phase (initiation phase) drugs - 2 Months: INH, Rifampin (RIF), pyrazinamide (PZA) and ethambutol (EMB) active TB 2nd phase (continuation) drugs - 4-7 months: INH & RIF antiviral drugs: nucleoside analogues - Acyclovir (Zovirax), valacyclovir Famciclovir Ganciclovir cidofovir valgancidovir ribavirin Acyclovir (Zovirax) indications - HSV-1 & 2, varicella-zoster virus, EBV, herpes virus 6, CMV, Valacyclovir (Valtrex) indications - HSV-1 & 2, varicella-zoster virus, EBV, herpes virus 6, CMV, famciclovir indications - HSV-1 & 2, EBV, Hep B Ganciclovir indications - CMV Ribavirin indications - Chronic Hep C, RSV antiviral (nucleoside analogues) mechanism of action - interferes with DNA synthesis & inhibiting viral replication Antivirals for Influenza (neuraminidase inhibitors) - oseltamivir (Tamiflu), (PO) zanamivir (inhaled) Peramivir (IV) Ketoconazole indications - vulvovaginal candidasis paronychia fungal PNA esophageal candidasis Fluconazole indications - candidiasis, cryptococcal meningitis severe systemic infections, vaginal candidasis oropharyngeal candidasis esophageal candidasis Itraconazole (Sporanox) indications - blastomycosis, nonmeningeal histoplasmosis, Posaconazole (Noxafil) indications - oropharyngeal candidiasis Voriconazole (Vfend) indications - invasive aspergillosis Terbinafine (Lamisil) indications - onychomycosis of fingernails and toenails Amphotericin B - severe systemic fungal infections: HIGHLY TOXIC Griseofulvin indications - Oral treatment of superficial infections- dermatophytes (tinea, ringworm) tinea capitis (1st line drug) Miconazole (Monistat) indications - Primarily used for vaginal candidiasis. Antifungal monitoring - monitor for liver toxicity Anthelmintic (antiparasitic) drugs - mebendazole thiabendazole albendazole pyrantel ivermectin Benzimidazoles MOA - Interfere with elongation of the microtubules that are responsible for parasitic cellular structure, leading to a disruption of growth and division Pyrantel MOA - paralyzes worms to allow expulsion by peristalsis Ivermectin MOA - intensifying GABA-mediated signal transduction in peripheral nerves (causing worm paralysis) Mebendazole (Vermox) indications - DOC for intestinal & tissue nematodes (roundworm) Nematodes - Intestinal and tissue roundworms Cestodes - flatworms and tapeworms Trematodes - flukes Albendazole (Albenza) indication - tissue nematodes: hookworm, trichiasis giardiasis Pyrantel indications - pinworm, trichiasis, hookworms Ivermectin (Stromectol) indications - tissue nematodes patient education for albendazole & mebendazole - take with a high fat meal patient education for ivermectin - take on empty stomach Tinea Capitis (Scalp Ringworm) treatment - terbinafine Griseofulvin (1st line therapy) Tinea Cruris (Jock Itch) Treatment - naftifine butenafine ciclopirox olamine onychomycosis - ciclopirox 1st line treatment for primary and secondary skin infections - 1st generation Cephalosporins: cephalexin dicoxacillin amoxilcillin/claulanate clindamycin medications and dose to eradicate nasal MRSA - intranasal mupirocin: 1/2 tube in each nostril BID x 5 days symptomatic treatment for viral URIs - decongestant Tylenol ASA Motrin increase fluid intake cough drops nasal saline spray rest treatment for acute sinusitis - amoxicillin with or without clavulanate Antacids MOA - Neutralize gastric acid to bring the pH above 3 and inactivate pepsin