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Unit 4 Meds
Pulmonary Drugs
| Question | Answer |
|---|---|
| Spacers | Increased delivery of drug to lungs; use especially w/ corticosteroids due to risk of thrush |
| Metered Dose Inhalers | Small, hand held, pressurized devices, hand-lung coordination. 10% reaches lung, 80% hits oropharynx and is swallowed |
| Dry Powder Inhalers | Breath activated, no hand lung coordination, 20% gets to lung |
| Nebulizers | Converts liquid to mist. Face mask or mouthpiece used; med delivers over several minutes; same amount of med as in one puff |
| Glucocorticoids | Vancenase, Pulmicort, Flovent/Flonase, Nasonex, Nasocort |
| Nasonex & Nasocort | Intranasal. S/E: drying of nasal mucosa, burning/itching, sore throat, epistaxis, not as effective if nasal congestion present |
| Corticosteroids | Inhaled = 1st line of therapy for asthma. Oral use for severe asthma; when symptoms not controlled with inhalation and bronchodilators |
| Vancenase, Pulmicort, Flovent/Flonase, Nasonex, Nasocort | S/E w/ chronic use: adrenal suppression & bone loss, oropharyngeal candidiasis and dysphonia. Prevent by gargling after admission, use spacer. Prevent bone loss by using lowest dose possible, adequate Ca+, Vit D, & wt bearing exercises |
| Leukotriene Modifiers | Compounds that promote bronchoconstriction, inflammation, mucus production and edema. -- Effects are not immediate |
| Name the Leukotriene Modifiers | Zyflo & Singulair |
| Zyflo | Blocks leukotriene synthesis, used for adults and children >12 yrs; hepatotoxic, monitor ALT, competes with theophylline & coumadin (increases drug levels) |
| Singulair | Leukotriene receptor blocker. Use prophylactically and maintenance; Prevention of exercise induced bronchospasm; relief of allergic rhinitis; not immediate, not hepatotoxic, does not increase drug levels |
| Methylxanthines | Theophylline |
| Theophylline | Causes bronchodilation; narrow therapeutic range; only given PO. Used w/ chronic, stable asthma to decrease frequency and severity of attacks. Wide variations in metabolic rates |
| Theophylline (2) | Dosage based on individual and therapeutic range 5-15. Levels 20-25 = nauseau, vomiting, restleness. Levels >30 dysrhythmias (Vfib), seizures, avoid w/ caffeine |
| Cromolyn (Nasalcrom, Intal) | Used for seasonal allergy attacks and exercise induced bronchospasm - give 15 minutes before. |
| Nasalcrom | Given intranasal for allergic rhinitis |
| Intal | Given inhalation |
| Nasalcrom & Intal | Decrease bronchial inflammation, not a bronchodilator. Used prophylactically, not quick relief, no systemic effects, may be used instead of steroids |
| Beta 2 Adrenergic Agonist (Bronchodilators) | Albuterol, Levalbuterol, Serevent, Advair |
| Beta II Adrenergic Agonist | Provides symptomatic relief but does not address underlying cause; most need w/ long term steroid. Most effective for relieving acute bronchospasm |
| Activate Beta 2 receptors | In smooth muscle of lungs causing bronchodilation suppressing histamine release in lung and increase ciliary motility. Available PO or inhalation. PO = long acting |
| Short Acting Beta 2 Adrenergic Agonist | Albuterol, Levalbuterol |
| Albuterol & Levalbuterol | Given by inhalation. Begin Immediately; peak 30-60 min, persist for 3-5 hrs. Used to abort an attack but not effective for long term prophylaxis |
| Short Acting (albuterol & levalbuterol) | Exercise induced bronchospasm - take 15 minutes before. Available MDI, DP, nebs, inhalers |
| Long Acting Beta 2 Adrenergic Agonist | Serevent |
| Serevent | Takes effect in 10-30 minutes. |
| Oral Antihistamine drugs | Chlor-Trimeton, Benadryl, Tavist, Zyrtec, Allegra, Claritin, Clarinex |
| First Generation Oral Antihistamines | Chlor-Trimeton, Benadryl, Tavist |
| Second Generation Oral Antihistamines | Zyrtec, Allegra, Claritin, Clarinex |
| Oral Antihistamines | Relieve rhinorrhea, sneezing, nasal itching but not congestion, most effective when taken prophylactically on a regular basis |
| 1st Generation Oral Antihistamines | S/E: sedation, dry mouth, urinary hesitancy, constipation due to anticholinergic effects |
| 2nd Generation Oral Antihistamines | NO SEDATION, few side effects |
| Sympathomimetics | Neosynephrine, Sudafed, Dristan, Atrovent, Spiriva |
| Sympathomimetics (Decongestants) | Activating alpha adrenergic receptors, decrease nasal congestion by vasoconstriction, shrinks, swollen membranes |
| Sudafed | Can be converted to methamphetamine, must be kept behind counter, sign a log, no more than 9 g/month or 3.6 g at one time |
| Neosynephrine, Sudafed, Dristan | Allergic rhinitis to relieve stuffiness, lower congestion of sinusitis and coid. S/E: rebound congestion, increase dose for symptom relief, limit 3-5 days of use, may need steroid, CNS excitation, restless, anxiety, systemic vasoconstrict, watch heart pts |
| Atrovent | Onset 30 sec, max 3 min, last up to 6 hrs. S/E: dry mouth, irritation pharynx, avoid if peanut allergy, contains soya lectithin. 10% anaphylaxis. Combo w/ aluterol is called duoneb |
| Atrovent & Spiriva (anticholinergic) | Block muscarinic receptors in bronchi causing dilation, used on COPD, off label use for asthma. Inhalation only |
| Spiriva | Long acting, onset 30 min, peak 3 hrs, last 24 hrs, given 1x daily. S/E: dry mouth, DPI, additive benefits w/ Beta 2; two different ways to dilate |
| Drugs for Coughing | Codeine, Dextromethophan, Mucinex, Mucomyst |
| Antitussives | Codeine & Dextromethophan |
| Expectorants & Mucolytics | Mucines & Mucomyst |
| Codeine | Decreases frequency and intensity of cough; low dose; 1/10 of dose used for pain; potential for abuse |
| Dextromethophan | Non-opioid antitussive; taken at high doses can cause euphoria and can be abused for this purpose |
| Expectorant | Stimulates flow of respiratory secretions |
| Mucolytics | Breaks up mucus |
| Mucomyst | Given by inhalation; watch for bronchospasm, contains sulfur |
| Selective Toxicity | Ability of drug to injure a target cell or organism without injuring other cells; without causing injury to host |
| Inhibition of Enzyme | Unique to bacteria; ex) folic acid - bacteria make folic acid which is needed for bacterial survival |
| Disruption of protein synthesis | Ribosomes in bacteria are different than ribosomes of mammalian cells |
| Bactericidal | Directly lethal to bacteria |
| Bacteriostatic | Slows bacterial growth but does not cause cell death. Elimination of bacteria must be accomplished by host immune defenses |
| Penicillins & Cephalosporins | Inhibit bacterial cell wall synthesis or activate enzymes to disrupt cell wall |
| Increase cell membrane permeability | Amphotericin B - causes leakage of intracellular material |
| Aminoglycosides | Lethal inhibition of protein synthesis |
| Non-lethal inhibition of protein synthesis | Tetracyclines - only slow bacterial growth |
| Inhibit bacterial synthesis of DNA/RNA | Binds directly to nucleic acids or enzymes that make nucleic acids: rifampin, metronidazole, fluorquinolones |
| Antimetabolites | Disrupt specific biochemical reactions: Trimethoprim & Sulfonamides |
| Suppress viral replication | inhibit specific enzymes |
| Microbial Mechanism | Decrease drug concentration at its site of action (intracellular), ease active uptake, increase active export. Produce drug metabolizing agent. |
| Microbial Mechanism 2 | Change structure or receptor site or target molecules (ribosomes). Produces compound that antagonizes drug action |
| Acquired Resistance | Spontaneous (random) mutation. Conjugation: combining of 2 bacterial DNA; common in gram (-) bacteria; could use normal flora |
| Antibiotic Use | Normal flora competes w/ each other. When used, normal flora changes, bacterial flourish. Broad spectrum antibiotics increase chance of resistance |
| Antibiotic Use (2) | Nosocomial infections are among the most difficult to treat; more exposure to antibiotics |
| Vaccinate | Prevents infections |
| Disconnect invasive lines, catheters | Leading cause of nosocomial infections |
| Target the pathogen | Use only antibiotics the bacteria is sensitive to |
| Expert | Consult infectious disease specialist; right antibiotic for right amount of time |
| Antimicrobial control | Standing orders for bacteria/infections; evaluate effectiveness |
| Treat bacteria not colonization | Just because bacteria is present doesn't mean it is an infection |
| Gram (+) | PCN can easily penetrate thick cell wall and reach the PCN binding proteins on cytoplasmic membrane |
| Gram (-) | Most PCN's cannot penetrate outer membrane |
| Beta Lactamases | Enzymes that break down Beta lactam ring; can be produced by both gram (+-) bacteria. |
| What is #1 adverse effect of PCN's | Allergic reaction |
| PCN Binding Proteins | Receptor site for drug; only available during growth and division of bacteria cell; PCN's have no direct effect on cells of host b/c they don't have cell wall making them very safe. PCN breaks cell wall; cell takes up H2O and ruptures. PCN is bactericidal |
| Penicillins | Penicillin G, Pipracil, Piperacillin/tazobactam, Augmentin |
| Penicillin G | first PCN available; active against most gram (+) bacteria. Most gram (-) are resistant; given IM or IV, intra arterial injection can produce severe reactions. MUST AVOID |
| Pipracil | Broad spectrum, given IV, decrease dosing for impaired renal function |
| Piperacillin/tazobactam (Zosyn) | Contains tazobactam, a beta lactamase inhibitor (prevents the bacterias beta lactase enzyme from breaking down the antibiotic which is the piperacillin) |
| Amoxicillin/clavulante(Augmentin) | May be given orally. S/E: rash & DIARRHEA. Clavulante, a beta lactamase inhibitor protecting the antibiotic (amoxicillin) from the bacterias beta lactamase enzymes |
| Cephalosporin | Binds to PCN binding proteins; has a beta lactam ring, bactericidial; most effective against bacteria undergoing cell division and growth |
| Cephalosporins Resistance | Based on bacteria's ability to break down beta lactam ring |
| 1st Generation Cephalosporin | Destroyed by beta lactamase enzymes; used for gram (+) |
| 2nd Generation Cephalosporin | Less sensitive to beta lactamase enzymes; first and second generation do not reach CSF |
| 3rd & 4th Generation Cephalosporin | Highly resistant to beta lactamases. Given IV. Reserved for active infections; strong antibiotics "big guns" |
| Cephalosporins Pharmacokinetics | PO absortion from GI tract; usually given IM/IV; most eliminated by kidneys, may need to decrease dose if renal impairment |
| Cephalosporins Adverse Effects | Hypersensitivity reactions: rash for several days after onset of use; risk of bleeding (interferes with vitamin K metabolism); thrombophlebitis |
| Cephalosporins Drug Interactions | Meds that promote bleeding; interacts with Probenecid (delays excretion) |
| Cephalosporin Drugs | Cefazolin, Cefzil, Ceftin, Rocephin, Maxipime |
| First Generation Cephalosporin (Drug & Routes) | Cefazolin: IM, IV |
| Second Generation Cephalosporins (Drugs & Route) | Cefzil, Ceftin, PO. Not typically used for active infections, used prophylactically w/ surgical pts |
| Third Generation Cephalosporin (Drug & Route) | Rocephin: IM, IV -- Do NOT mix w/ calcium containing IVF/IVPB |
| Fourth Generation Cephalosporin (Drug & Routes) | Maxipime: IM, IV |
| Carbapenems Drugs | Imipenem & Cilastatin |
| Cilastatin | Inhibits destruction of imipenem by renal enzymes |
| Carbapenems | Very broad spectrum antibiotic. IV only. Able to penetrate gram (-) outer membrane. S/E: N/V, diarrhea, hypersensitivity reactions |
| Vancomycin | Reserved for serious infections, does NOT contain beta lactam ring. Given IV except for infections of GI tract; excreted by kidneys. Uses: CDIFF, MRSA, allergy to PCN |
| Vancomycin S/E: | nephrotoxic, ototoxic (ringing in ears), loss of hearing, rapid infusion may cause "red man syndrome": flushing, tachycardia, hypotension, rash, pruritis. Monitor serum levels do peaks/troughs |
| Azactam | Binds to PCN binding proteins; not effective against anaerobes or gram (+) bacteria; only against gram (-). Highly resistant to beta lactamases |
| Azactam S/E: & Routes | Pain and thrombophlebitis at site of injection. Given IM/IV |
| Tetracycline Drugs | Tetracycline & Doxycycline = Suppress bacterial growth by inhibiting protein synthesis. Take w/ full glass of H2O, use straw if liquid formula (don't let touch teeth) |
| Tetracycline | Take on empty stomach, eliminated by kidneys, avoid w/ renal failure |
| Vibramycin | Can take w/ food, eliminated by liver, OK to use w/ liver failure |
| Tetracycline & Vibramycin S/E: | GI irritation, binds to salts, do not give w/ Ca+ supplements/dairy products/iron supplements/Mg containing antacids or laxatives (discolor teeth from yellow to brown). CDIFF is common |
| Macrolide Drugs | Biaxin & Zithromax |
| Macrolides | Broad spectrum antibiotics w/ BIG molecules, usually bacteriostatic; may be used as alternative to PCN; active against many gram (+) and some gram (-). Inhibits protein synthesis (binds to ribosomes) |
| Macrolide Uses | Pertussis, whooping cough, diptheria, chlamydia, some pneumonia. Feed decreased absorption; eliminated by liver |
| Macrolide S/E: | GI upset, QT prolongation leading to TorSades and sudden cardiac death; avoid w/ antidysrhtymics and calcium channel blockers. Increases levels of theophylline and coumadin |
| Biaxin | Used for respiratory tract infections & H pylori |
| Zithromax | Used for respiratory tract infections, chlamydia; absorption increases w/ food |
| Cleocin | Severe group A streptococcal infections. Active against anaerobic bacteria (Gram + -). Usually bacteriostatic. Inhibits protein synthesis |
| Cleocin S/E: | Pseudomembranous colitis (CDIFF), abdominal pain, fever, leukocytosis; stools (+) for mucus & blood |
| Zyvox | Oxazolidinone; activity against multidrug resistant gram (+) bacteria, VRE, MRSA. Inhibits protein synthesis |
| Zyvox S/E: | myelosuppression AKA decreases WBC, RBC, platelet |
| Aminoglycosides - Drug | Gentamycin |
| Gentamycin | Disrupts protein synthesis, bactericidal d/to production of abnormal proteins |
| Gentamycin S/E: | ototoxic, nephrotoxic, monitor peaks and troughs |
| Gentamycin -- Uses & Routes | Aerobic gram (-) bacilli; cannot kill anaerobes, need O2 to transport medication across membrane. Given IV only, may give PO for bowel infection only; decrease dose or increase interval for renal pts |
| Fluoroquinolones - Drugs | Cipro & Levaquin |
| Cipro & Levaquin uses | Respiratory, Urinary, GI, bone/joint, skin, soft tissue infects. Absorption decreased w/ Al, Mg, Ca, Fe & dairy |
| Cipro & Levaquin S/E: | Tendon rupture (achilles), GI upset, candida inf of pharynx & vagina; CNS: dizziness, confusion (elderly), phototoxicity |
| Metronidazole Drug | Flagyl |
| Flagyl | Used for CDIFF, H Pylori, abdominal & vaginal surgery. |
| Flagyl S/E: | nausea, dry mouth, unpleasant metallic taste; darkening of urine; avoid alcohol, may need to decrease coumadin dose |
| Anti-fungal Drugs | Amphotericin B, Azoles (Sporonox, Diflucan, Vfend), Cancidas |
| Amphotericin B | Active against broad spectrum fungi, given IV. Used as last ditch effort, not common. BIG DANGEROUS DRUG!!! |
| Amphotericin B S/E: | Premedicate w/ Benadryl & Tylenol, corticosteriods. Phlebitis: change peripheral IV sites, give thru central line. Nephrotoxic: renal impairment occurs in almost all patients, avoid other nephrotoxic drugs. Bone marrow suppression |
| Azoles - Drugs | Sporonox, Diflucan, Vfend |
| Sporonox | Take w/ food NOT w/ antacids |
| Azoles action | Broad spectrum antifungal; lower toxicity than Ampho B, given PO. Increases membrane permeability |
| Sporonox, Diflucan, Vfend uses: | Blastomycosis, histoplasmosis, candidiasis |
| Azoles S/E: | Cardiosuppression & liver injury - use cautiously in cardiac & liver patients |
| Cancidas | Given IV, disrupts cell wall; Better tolerated than Ampho B, S/E: phlebitis. Used for aspergillus or candida only |
| TB Drugs | INH, Rifadin, PZA, Myambutol |
| INH | bactericidal to actively dividing organisms. Must take 6 mos, preferred 9. |
| INH S/E: | liver damage; excreted by kidneys, increase risk of liver damage w/ advancing age; peripheral neuropathy d/t lowered levels of vit B6 |
| Rifadin | Bactericidal to TB. Take on empty stomach. Eliminated by hepatic metabolism; hepatotoxic |
| Rifampin S/E: | Red-orange discoloration of urine, tears, sweat & saliva |
| PZA | Bactericidal to TB, hepatotoxic, increases uric acid (inhibits excretion) |
| Myambutol | Bacteriostatic, may be used to treat TB resistant to INH or Rifadin |
| Myambutol S/E: | Optic neuritis (blurred vision, constriction of visual field, changes to color discrimination); inhibits uric acid excretion |
| Zovirax | Only active against herpes virus family (chicken pox, herpes, shingles) S/E: IV - phlebitis, nephrotoxic PO - N/V/D/HA not nephrotoxic |
| Chemo Agent Drugs | Carboplatin & Taxol |
| Carboplatin | Used for small cell lung cancer. S/E: bone marrow suppression, N/V, nephrotoxic. Watch for hearing loss |
| Taxol | Used for non-small cell lung cancer. S/E: severe hypersensitivity infusion reactions (hypotension, dyspnea, angioedema, urticaria-hives) premedicate w/ Benadryl, corticosteroids; bone marrow suppression; alopecia; bradycardia |
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kristyd02
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