PHARMACOLOGY MIDTERM Reviewer Denielle Genesis B. Camato

02272015

Anti- infectives Antibacterial Antitubercular Antifungal Antiviral

ANTIBACTERIAL

Penicillins Are bactericidal; they interfere with cell

wall synthesis by inhibiting biosynthesis of cell wall mucopeptides

Indicated for treatment of infections caused by –

Gram positive cocci Gram negative cocci Gram positive bacilli

Penicillin G Ampicillin Amoxicillin Augmentin Methicillin

Notes!Bactericidal – killBacteriostatic – preventAnti-infection – infectionAnti-inflammatory – inflammation

Cephalosporins Are bactericidal due to their ability to

inhibit mucopeptide synthesis in bacterial cell wall.

Indicated for treatment of infections caused by gram positive and negative organisms

1st generations 2nd generations 3rd generationsCefazolin Cefamandole CeftizoxineCephalexin Cefuroxime ceftriaxone

Aminoglycosides Are bactericidal agents that inhibits

proteins synthesis and lysing the cell envelope

Indicated for treatment of infections caused by gram negative enteric (GI disorders) bacilli Streptomycin Amikacin Neomycin Gentamicin

Macrolides Are bacteriostatic by inhibiting the

growth of microorganisms without causing a complete kill

Indicated for treatment of infections caused by gram positive and negative bacteria Erythromycin

Tetracyclines Protein synthesis inhibitor Used for treatment for UTI, chlamydia and

acne Tetracycline Methacycline Doxycycline

Quinolones Are bactericidal that interferes with DNA

replication Indicated for treatment of STDs caused by

gonorrhea or chlamydia Ciprofloxacin Ofloxacin Norfloxacin

Sulfonamides Interferes with the synthesis of

paraminobenzoic acid (required for the synthesis of folic acid in the bacteria)

Indicated for treatment of infections caused by gram positive and negative organisms Sulfacytine Sulfamethizole Sulfamethoxazole Trimethoprim Phenazopyridine Nitrofurantoin

Patient education on anti-infectives Unless directed otherwise, taking all

antibiotics with a full glass of water on empty stomach, at least one before meals or two hours after meals.

Not taken with fruit juice, anatacids and alcohol.

If side effects occur, discontinue and consult physician.

Immediately report rash, swelling or breathing difficulty to the physician.

Take at prescribed times to maintain blood levels.

Take entire prescription completely; not to discontinue when symptoms disappear.

Antitubercular agents Used to treat tuberculosis causes by

Mycobacterium tuberculosis Agents kill or inhibit the growth of

mycobacterial organisms Drugs are commonly used in combination

First line agents (RIPES) Rifampicin Isoniazid (INM) with

vitamins B6 (pyridoxine to prevent neuropathy)

Pyrazinamide Ethambutol Streptomycin

Patient Education Taking rifampicin on empty stomach for

maximum absorption or with food if nauseated

Taking prescribed medication for lengthy required period of time even though asymptomatic

Reporting side effects for possible dosage adjustment

Importance of frequent medical and laboratory tests

Red orange color urine, feces, sputum, sweat and tears with use of rifampicin

Avoidance of alcohol

Antifungal agents Bind to components of the fungal cell

membrane, leading to death of the fungal cell

Used to treat infections caused by fungi, whether systemic or local

Systemic antifungal Amphotericin B Ketoconazole Miconazole Fluconazole Topical antifungal Griseofulvin Nystatin Clotrimazole

Antiviral agents Enter the virus and prevent further

replication of the virus Indicated when an infections process is

due to virus Nucleosides Protease inhibitors Miscellaneous antiviral agents

Nucleosides Interfere with replication of HIV by inhibiting

the action of the enzyme reverse transcriptase

Prophylaxis after initial exposure to HIV Zidovudine Zalcitabine Didanosine Stavudine Lamivudine

Protease inhibitors Stop the activity of the HIV protease and

prevent the cleavage of viral polyproteins, thereby preventing viral maturation

Used to treat HIV in selected clients Saquinavir mesylate Crixivan Norvir

Miscellaneous antiviral agents Act by blocking replication of the virus

Acyclovir Famciclovir Ganciclovir Amantadine Rifantidine Ribavirin

Anti-Inflammatory drugs Arthritis Bursitis Spondylitis Gout Muscle strains/sprains

5 Cardinal signs of inflammation Redness (Rubor) Heat (Calor) Swelling (Tumor) Pain (Dolor) Limited mobility (Functio laesa)

NSAID (NON STEROIDAL ANTI-INFLAMMATORY DRUGS)

Non steroidal anti-inflammatory drug Action Inhibit synthesis of prostaglandins

(causes pain)

Non-selective (Traditional) NSAIDs Diclofenac VOLTAREN Ibuprofen ADVIL Indomethacin INDOCIN Ketorolac TORADOL Naproxen NAPROSYN Oxaprozin DAYPRO Sulindac CLINORIL

Partially Selective NSAIDs Etodolac LODINE Meloxicam MOBIC Nambutone RELAFEN

Selective COX-2 Inhibitor Celocoxib CELEBREX

Combinations Diclofenac/Misoprostol ARTHROTEC Lansoprazole/Naproxen PREVACID NAPRAPAC

Gout medication Colchicines ALLOPORINOL

Patient Education Administration with food to reduce

gastric irritation Increase food intake Caution with dosage Discontinue if there is unusual bleeding

(gums, stool, urine and bruising), epigastric pain or nausea, tinnitus, visual disturbances, weight gaining or edema and skin rash

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CARDIAC DRUGS

Coronary Artery Disease (CAD)

Arteriosclerosis – Narrowing of coronary artery due to aging

Atherosclerosis – Narrowing due to Accumulator of fats, cholesterol, lipids

CARDIOVASCULAR DRUGS Cardiac Glycosides – indicated for

heart failureEx. Digoxin (Lanoxin) *Do not take if pulse is <60 >120 Digitalis toxicity 0.5-2.0 ng/mg

ANTIANGINAL AGENTS (chest pain) Nitrates

Isosorbide Dinitrite (Isordil) – Under the tongue (Sublingual)Isosorbide Mononitrate(Imdur) – OralBeta blockers – Action: Blocks the action of cathecolamines (Adrenaline)

Ex. Propanolol, Athenolol, MetoprololNitroglycerine – most common nitrates, IV, Sublingual, ointment, transdermal, oral

Action: it relaxes the muscle to promote vasodilation

Most common side effects; headache, hypotensionCalcium Channel Blockers – Action: Blocks calcium; leading to muscle dilation

*Antihypertensive drug

Myocardial ischemia - ( decrease Blood Supply)

- (decrease O2 supply)

CAD

Angina pectoris ( decrease Oxygen supply)

(Chest pain)

Myocardial infarction/heart attack – (necrosis of the myocardium)

Heart failure – inability of the heart to pump

Death

ANTIHYPERTENSIVE AGENTS*2 types:Primary – due to other diseasesEssential – aging

to lower angiotensin 1&2 120/80 Pre-hypertension

1) ACE inhibitors – Andiotensin Converting enzymes

2) Calcium Channel Blockers

3) Diuretics 5 types

Carbonic Anhydrase Inhibitors Loop diuretics – promotes excessive fluid; urine Potassium Sparring Diuretics Thiazides and Related Diuretics Osmotics

ANTIHYPOTENSIVE AGENT – increase blood pressureHypotensionShockCardiac arrest

ANTIDYSRRYTHMICSq Acts to restore a normal

cardiac rhythmq Indicated for atrial or

ventricular tachycardia or atrial fibrillation

q Monitor ECGq V-tachycardiaq Normal: 60-100 beats per

minuter 80 is the averager below 60 – bradyycardia

(slow heart rate)r above 100 – tachycardia

(fast heart rate)

LIPID LOWERING AGENTS

q lowers cholesterol levels

q hepatotoxic

ANTIPLATELET DRUGS

q decrease platelet aggregation/clumping

q inhibit thrombus formation

r thrombus – stationary

r embolus – wandering

ANTICOAGULANTS

q Prevent clot formation

q “blood thinner”

q COUMADIN

r Interfere with the action of vitamin K

r Oral

r Antidote vitamin K (promote synthesis of blood clotting)

q HEPARIN

r Inhibit the action of fibrin in clot formation

r Parental IV or SC

r Antidote PROTAMINE SULFATE

THROMBOLYTIC AGENTS

q Dissolves blood clots

q “clot busters”

q risk for hemorrhage

HEMORRHEOLOGIC AGENTS

q improves capillary blood flow by increasing RBC flexibility & decreasing blood viscosity

q Buerger’s disease

r Intermittent claudication caused by chronic occlusive arterial disease of the limbs

[ Cyelandilate (cyclan)

[ Isoxsuprine (vasodilan)

HEMOSTATIC AGENTS

q Used to control bleeding

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