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Unit 4 Meds

Pulmonary Drugs

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
Created by: kristyd02