Resp. Med Cards
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| Meds By Inhalation | Therapeutic effects enhanced, delivery of drug directly to site of action; min systemic S/E
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| Metered Dose Inhaler | Small hand-held, pressurized; measured does w/each puff; w/opt. use only 10% reaches lungs
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| Spacers | Increase delivery to lungs
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| Dry Powders | 20% get to lungs
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| Glucocorticoids--Inhalation, oral or IV | Most effective anti-asthma drug; suppresses inflammation, decreases edema of airway secondary to decreasing vascular permeability, decrease mucus production
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| Uses and S/E of glucocorticoids | Prophylactic use, NOT PRN. S/E: , Adrenal suppression, bone loss, decreased healing, hyperglycemia, oropharyngeal candidiasis & dysphonia--gargle to prevent; with prolonged use, must increase PO & IV doses in time of stress
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| Nasonex Nasocort | intranasal glucocorticoids; S/E:drying of nasal mucosa, burning/itching, sore throat, epistaxis--not as effective w/stuffy nose **improvement 2-8 days; max benefit 4-6 wks
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| Vancenase Pulmicort Flovent Flonase | anti-asthma glucocorticoids; inhale, IV or PO, decre inflamm, decre edema of airway, decre vascular permeability, decre mucus production--prophylactic, not PRN *S/E: decre growth rate of children for one yr
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| Zyflo | Effects not immediate; leukotriene modifier--blocks leukotriene synthesis; used in >12 yo; hepatotoxic, monitor ALT, competes w/theophylline, coumadin (incr drug levels)
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| Leukotrienes | Compounds promote bronchoconstriction, inflammation, mucos production and edema
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| Singulair | Leukotriene receptor modifier; used prophylactically & maintenance, prevention of exercise induced bronchospasm; Relief of allergic rhinitis NOT immed; NOT hepatotoxic, does not incr drug levels
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| Nasalcrom--intranasal Intal--inhalation | Effective for seasonal allergy attacks; used for exercise induced asthma--give 15 min prior to exercise; decrea bronch inflamm; NOT bronchodilator; use prophylactic, NOT PRN; no systemic effects; may be used instead of steriods
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| Theophylline avoid caffeine | NOT COMMONLY USED--causes bronchodilation, narrow therap range; given PO, does not work inhaled--Use w/chronic, stable asthma to decrea freq & sev of attacks; wide var in met rates, dose based on indiv; thera level 5-15, levels 20-25 cause N/V; vfib,seiz
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| Bronchodilators Beta 2 Adrenergic Agonist | Active Beta 2 receptors in smooth muscle of lungs cause bronchodilation, suppreses histamine release in lungs & increa ciliary motility; Avail PO or inhalation--all PO are long-acting
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| Albuterol | short-acting; provides symp relief, does not address underlying prob--most also need steriod; most eff relieving acute bronchospasm; Inhale-begin immed; peak 30-60 min, persist 3-5 hr; S/E:increa HR, angina, tremors
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| Xopenex | short-acting bronchodilator; used in addit to sterioids; provides relief, doesn't fix prob; Inhaled-immed action; peak 30-60 min, 15 in prior exercise; S/E: increa HR (short-term), angina, tremors
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| Serevent | Long-acting bronchodilator; PO or inhale q12h, fixed schedule, not 1st choice for attack, should be used w/steroid; onset 10-30 min
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| Advair | Combo (Flosnase/Flovent & Serevent); onset 10-30 min, inhale q12h, use w/steroids; S/E of steriods: increa HR, tremor
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| 1st Gen antihistamine | Relieves rhinorrhea, nasal itch, not congestion--take prophylactic on reg basis. S/E: sedation, dry mouth, urinary hesitancy, constipation
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| Benadryl Chlor-Trimeton | 1st gen antihistamines, relieve rhinorrhea, sneezing, nasal itching, but NOT congestion. Most effective taken prophylactic, on reg basis. S/E: sedation, dry mouth, urinary hesitancy, consipation
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| Zyrtec Allegra Claritin Clarinex | 2nd gen antihistamines; relieve rhinorrhea, sneezing, nasal itching, NOT congestion; take prophylactic on reg basis. S/E: Few, NO sedation
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| Decongestants | decrea nasal congest by vasocontricting, shrinks swollen membrances. Uses: allergic rhinitis to relieve stuffiness, decrea congestion of sinusitis & colds. S/E: rebound congest, increa dose needed for sympt relief; limit 3-5 days; may need steriod
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| Dristan | decongestant, S/E: CNS excitation, restless anxiety, systemic vasoconstriction; watch cardiac pts
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| Neosynephrine | decongestant, S/E: CNS excitation, restless anxiety, systemic vasoconstriction; watch cardiac pts
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| Sudafed | decongestant, S/E: CNS excitation, restless anxiety, systemic vasoconstriction; watch cardiac pts**Can be converted to meth--buy 3/6 g at a time, 9g/mo
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| Anticholinergic | Blocks muscarinic receptors in bronchi causing dilation, used for COPD, off label use for asthma, inhalation only
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| Atrovent | Anticholinergic; Onset 30 sec, max 3 min, lasts 6h. S/E: dry mouth, irritation of pharynx, avoid is PB allergy; contains soya lechthin, 10% anaphylaxis
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| Combivent duoNeb | Combo of Atrovent & albuterol
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| Spiriva | anticholinergic; long-acting, onset 30 min, peak 3hrs, last 24h; given once daily. S/E: dry mouth; DPI; additive benefits w/beta 2; 2 diff ways to dilate
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| Codeine | antitussive for couging; decrease freq & intensity of cough; low dose; 1/10 dose use for pain; potential for abuse
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| Dextromethophan | antitussive for coughing; non-opioid; taken at high doses cause euphoria & can be abused
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| Mucinex | Expectorant & mucolytic, Expectorant: stimulates flow of respiratory secretions, Mucolytic: breaks up mucus
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| Mucomyst | Expectorant & Mucolytic; stimulates flow of resp secretions & breaks up mucus; Given by inhalation; watch for bronchospasm, contains sulfur
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| Ways to prevent resistance to antibiotics | 1)Vaccinate; prevent infections, 2)D/C invasive lines, 3)Target the pathogen, 4)consult infectious disease MD,5)Antimicrobial control,6)tx bacteria, not colonization; bacteria doesn't=infection
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| #1 adverse effect of PCNs | Allergic reaction; Allergic to one, allergic to all
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| PCN | MOA:binding proteins are receptor sites for drugs; only available during growth & div of bacteria
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| Gram (+) bacteria | PCN easily penetrate thick cell wall & reach PCN binding proteins on cytoplasmic membrane
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| Gram (-) | Most PCN cannot penetrate outer membrane
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| Penicillin G | 1st PCN available, MOA: inhibit bacterial wall synthesis or activate enzymes to disrupt cell wall; Active against most gram (+), resistant most (-); give IM or IV--AVOID intraarterial...produces severe reactions (necrosis, gangrene)
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| Piperacillin | inhibits baterial cell wall synthesis or activate enzymes to disrupt cell wall; broad spectrum, given IV; decrease dosing for impaired renal function
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| Zosyn | inhibits bacterial cell wall synthesis or activate enzymes to disrupt cell wall disruption; contains TAZOBACTAM (beta-lactamase inhibitor)prevents bacteria's beta lactamase enzyme from breaking down antibiotic in the piperacillan; given IV
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| Beta lactamases | Enzymes that break down beta-lactam ring; can be produced by both gram (+) & (-); PCN has beta lactam ring in its chem structure. By breaking down beta ring,PCN becomes ineffective against bacteria
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| Augmentin (Amoxicillan/clavulanate} | Clavulante is beta lactase inhibitor that protects antibiotic(amoxicillian) from bacteria; May be given PO; S/E: rash, diarrhea (very common)
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| Cephalosporin Method of Action, Resistance | MOA: binds to PCN binding proteins; has beta lactam ring, bactericidal; most effective vs bacteria undergoing cell div & growth. Resistance: based on bacteria's ability to break down beta lactam ring
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| Cephalosporin Generations | As progress through generations, incr activity vs gram (-) bact & anaerobes, incr resistance to beta lactamase, inc ability to reach CSF. 1st gen-used for gram (+), destroyed by beta lactamase, 2nd gen less sensitive to beta lactamase, don't reach CSF.
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| Cephalosporin Pharmaco, Adv. Effects | Pharm:PO absorption from GI tract; usually given IV/IM, most eliminated by kidney, may need to decr dose if renal pt. S/E: hypersensitivity reactions, rash for sev days; risk of bleeding(interfers w/Vit K metab),thrombopheblitis.
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| Cephalosporin Drug Interactions | meds that promote bleeding; interacts w/Probenecid (delays excretion)
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| Cephalosporin | 1st gen, not typical for active infections; used for surgical pts; used for gram(+); destroyed by beta lactamase enzymes; most effective vs bacteria under cell division; DOES NOT REACH CSF
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| Cefzil Ceftin | 2nd gen; PO, not for active inf, surgical pts; less sensitive to beta lactamase; DOES NOT REACH CSF
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| Rocephine | 3rd Gen; given IV/IM, do NOT give w/Ca containing IVF/IVPB! Highly resistant to beta lactamase; incr ability to reach CSF; reserved for active infections "Big Guns"
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| Maxipime | 4th gen,IM/IV; reserved for active infections "BIG GUNS", highly resistant to beta lactamase; active vs anaerobes & gram (-), incr ability to reach CSF
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| Vancomycin | Reserved for serious inf; does not contain beta lactase ring. MOA: inhibits cell wall synth; does NOT interact w/PCN binding proteins; given IV except for GI inf (c.diff); excreted by kidneys; Use: c diff, MRSA, allergy to PCN
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| Vancomycin Adverse Effects | nephrotoxic, ototoxic, ringing in ears/less hearing. Rapid infusion may cause "red man syndr": flushing, tachycardia, hypotension, rash, pruritis--slow infusion to avoid, chg inf site dilate; peaks & troughs to monitor serum levels
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| Azactam | Contains beta lactam ring;MOA: binds to PCN binding proteins; not eff against anaerobes or gram (+) bacteria,only vs gram(-) aerobic bacteria, highly resistant to beta latamase; S/E:pain&thrombophelbitis@inj site
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| Azactam uses | gram(-) aerobic bacteria; given IM/IV; eliminated via kidneys
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| Tetracyclines | Broad spectrum, bacteriostatic;use of tetracycline decreased; MOA:suppress bacteria growth by inhibiting protein synthesis; Use: chlamydia, lyme's disease, H. pylori;topically or orally for acne
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| tetracycline adverse effects | GI irritation; binds to salts, do NOT give w/Ca suppl, dairy, Fe, Mg containing antacids or laxatives--can discolor teeth yellow to brown; avoid <8yoa, photosensitivity. C diff common, yeast inf (mouth, vaginal); take with 8oz H2O; use straw if liq form
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| Sumycin | Take on empty stomach; eliminated by kidneys, avoid w/renal failure
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| Vibramycin | Can take w/food; eliminated by liver, OK to use w/renal failure
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| Biaxin Zithromax | Broad spectrum antibiotics; very BIG molecules; usually bacteriostatic; may be used as alternative to PCN; active vs many gram (+) & some gram(-).MOA:inhibits protein synth (bind to ribosomes)
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| Uses of Biaxin & Zithromax | Pertussis, whooping cough, diptheria, chlamydia, some pneumonia; food decreases absorption; eliminated by liver
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| Adverse effects of Biaxin & Zithromax | GI upset, QT prolongation; can lead to TorSades & sudden cardiac death; avoid use w/antidysrhythmias & calcium channel blockers. Drug Interactions: increases level of theophylline & coumadin
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| Biaxin | Macrolide; used for respiratory tract infect, H pylori
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| Zithromax | Macrobide; used for resp tract infections, chlamydia; absorption increases w/food
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| Cleocin | Active vs anaerobic bacteria (+)or(-); usually bacteriostatic; MOA:inhibits protein synth. Uses:severe group A streptoccal inf. S/E:pseudomembranous coilitus-c diff, profuse watery diarrhea, abd pain, fever, leukocytosis; stool (+) for mucus & blood
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| Zyvox | Oxazolidinone; active vs multidrug resistant gram(+) bacteria, VRE, MRSA.MOA:inhibits protein synthesis.Uses:VRE, MRSA, not active vs gram(-) bacteria.S/E:mylosuppresion AKA decr WBC,RBC platelets
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| Gentamycin | Aminoglycoside MOA:disrupts protein synth; bactericidal due to production of abnormal proteins. Uses:aerobic gram(-)bacilli;cannot kill anaerobes,need O2 to transport medication across membrane
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| Gentamycin Pharm & S/E | Pharm:given IV ONLY; may give PO for bowel infection only; decr dose or incr interval for renal pts. S/E:ototoxic, nephrotoxic, monitor peaks & troughs
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| Cipro fluoroquinolone Absorption decreased w/Al,Mg,Ca,Fe & dairy products | MOA:disrupts replication of cell division.Uses:resp,urinary,GI,bone,joints,skin,soft tissue infect.S/E:tendon rupture, usually achilles,watch for pain & tenderness; GI upset,candida of pharynx&vagina, CNS:dizzness, confusion-esp elderly; phototoxicity.
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| Levaquin fluoroquinolone | MOA:disrupts replication of cell division.Uses:resp,urinary,GI,bone,joints,skin,soft tissue infect.S/E:tendon rupture, usually achilles,watch for pain & tenderness; GI upset,candida of pharynx&vagina, CNS:dizzness, confusion-esp elderly; phototoxicity.
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| Flagyl | used for protozoal & anaerobic bact.MOA:must be taken up by cells, breaks down DNA.Uses:c diff, abd & vaginal surg, H pylori. S/E:nausea, HA, dry mouth,unpleasant metallic taste; darkening of urine; avoid ETOH,may need to decrease coumadin dose
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| Amphotericin (Ampho B) | BIG DANGEROUS DRUG ; IV. Uses: fatal fungal infect.S/E:infusion reactions-fever, chills, nausea,HA; onset 1-3hr post infusion; premed w/benadryl, tylenol, c-steriods;phlebitis-chg perph insert site, give via CL
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| Amphotericin (Ampho B) side effects | infusion reactions, phlebitis, bone marrow suppression, nephrotoxic
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| Sporonox, Diflucan, Vfend | Azoles, lower toxicity than amphoB; can be give PO. Uses: blastomycosis, histoplasmosis, candidiasis. S/E: cardio suppression & liver injury; use caution in heart & liver pts. If PO, N/V, diarrhea
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| Sporonox | take w/food; do NOT take w/antacids
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| Cancidas (Caspofungin) | Given IV;Uses: aspergillus or candida only. S/E: phlebitis
Better tolerated than ampho B
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| Tuberculosis | slow growing microbe; req prolong tx; drug toxicity & pt compliance is issue; promotes emergence of drug resistance. Min tx 6mos up to 2yrs if resistant; 4 drug combo used to treat TB to reduce chance of resistance
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| INH | Bactericidal; must be taken min 6mos, prefer 9mos. S/E: liver damage; excreted by kidneys, incr risk of liver damage with age; peripheral neuropathy r/t decre level of vit B6-if take B6 w/INH decre s/s neuropathy
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| rifadin | bactericidal; take on empty stomach for best absorption; eliminated by hepatic mech; hepatotoxic; red-orange discolor urine, sweat, tears, saliva
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| PZA | bactericidal, hepatotoxic, incr uric acid (inhibits excretion)
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| Ethambutol | Bacteriostatic; S/E: optic neuritis (blurred vision/constriction of visual field, chgs to color discrimination); inhibits uric acid excretion
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| Zovirax | MOA: only active vs herpes virus family; decreases synthesis of viral DNA. Uses: chicken pox, herpes, shingles. S/E: IV-phlebitis, nephrotoxic, PO-N/V/D/HA, not nephrotoxic
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| Carboplatin | chemo agent used for small cell lung CA. S/E: bone marrow suppression; N/V occur, nephrotoxic, watch for hearing loss
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| Taxol | Chemo agent used for non-small cell lung CA. S/E: watch for severe hypersensitivity infusion reactions (hypotension, dyspnea, angioedema, urticaria-hives)pre-medicate w/corticosteroids, benadryl; bone marrow supp; alopecia, bradycardia
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