NURSING PHARMACOLOGY

DAY 2

GASTROINTESTINAL DRUGS
- Entir
Entire
e GI tract
tract isis unst
unsteri
erile
le – with
with nor normalmal fora
fora
o Outside is sterile - peritoneum
1. Pepti
Peptic
c Ulcer
Ulcer Disea
Diseasese
a. Can cause
cause GI bleedin
bleedin – deeper and and deeper !! imper"oration
imper"oration !! peritoneum !!
peritonitis
b. #tress can cause ulcer – nawawalan n blood suppl$ – shunted to other orans
c. #tr
#tress
ess ulc
ulcer
er
i. %elated
elated to to burns
burns – CurlCurlin in&s
&s ulcer
ulcer
ii. #econdar
#econdar$ $ to neuro
neuroloicloical al trauma
trauma-- Cushin&
Cushin&s s ulcer
ulcer
d. 'ood
ood actactss as a bu(e
bu(err
e. 'ood
'oods s that
that cause
cause ulcer
ulceratiations
ons
i. )ot
)ot and
and spic$ ic$
ii. 'att$
iii. Ca(e
Ca(ein ina
ated
ted
i*.
i*. )ih C)O+C)O+ – releases
releases pepsin pepsin !! more more astric
astric secret
secretion
ion
". ,anaement
i. ow
ow C)O+
C)O+ and and low
low "at-
"at- land
land Diet
Diet
1. /*oid
*oid mil0
mil0 – hih
hih in C)O+ C)O+
. ,edicatio
,edications ns - astri
astric c irri
irritant
tants s
i. /spirin
ii. #teroids
iii. +#/ID#
h. Cause
Cause bacter
bacteria ia – ). p$lo
p$lori ri
i. /ntib
/ntibiot
iotics
ics-- manae
manaemen mentt
i. 2$pes
i. Gastric
Gastric – 134 onl$5 normal normal astric
astric secretio
secretions
ns or h$posecr
h$posecretioetion
n o" stomach
acid- no antacids
1. )6 bloc0
bloc0er er lessen
lessen amountamount o" o" acid-
acid- do not i*e
6. Proble
Problem m mucus co*erin co*erin  walls o" stomac
stomach h – mas 0onti
0onti
a. Goal increase
increase mucus mucus prod
producti
uction
on
ii. Duodenal
Duodenal – most most common
common t$pe t$pe – 784 o" allall cases5
cases5 with h$per
h$peracid
acidit$
it$
1. Prob
Problemlem – h$pe
h$perac racidi
idit$
t$ – )Cl
)Cl
 9. ,edications
i. +eutra
+eutrali:li:ee astri
astric c acid
acid a"tera"ter meal
meals s
1. /ntacids
/ntacids – does not decre decrease
ase amount
amount o" acid
acid
a. ,anes
,anesium ium-- diarr
diarrhea
hea
b. /lu
/lumin
minum- um- consti
constipat
pation
ion
c. Calc
Calciuium m - const
constipipat
atio
ion
n
ii. Decre
Decreas ase e acid
acid prod
product uctionion
1. PPI- esomepr
esomepra:ol a:ole e - osec- be"or
be"oree meals ;P%/<OE
;P%/<OE#= #=
a. Prilo
Prilosec
sec – OmepraOmepra:ol :olee
b. )umber
)umber one dru dru alon
alon side with
with ). p$lor
p$lorii in"ection
in"ection
6. )6 bloc0ers
bloc0ers – cimetidine
cimetidine ;2aamet=> ranitidine;<antac=
ranitidine;<antac=-- a"ter meals
meals
a. Cimetidin
Cimetidine e can cause con"uscon"usion
ion – neuroto
neuroto?ic
?ic i" i*en
i*en with elderl$
elderl$
iii. Pro*ide
Pro*ide protprotecti
ecti*e
*e coatin
coatin o*er o*er ulcerat
ulcerated
ed site
site
1. #ucral"a
#ucral"ate te – cara"ate
cara"ate – be"or be"ore e meals-
meals- CO/2@
CO/2@
6. %ebamip
ebamipide ide ;mucos
;mucosta= ta=
A. Creates
Creates a paste paste !! didi0it didi0it sa ulcer !!!! tata0pan
tata0pan $un mucosamucosa--
sucral"ate
i*.
i*. incre
increas
ase e mucus
mucus produproducti ctionon
1. ,isopro
,isoprostol stol ;C$totec=
;C$totec= – a"ter a"ter meals
meals
 a. aborti"acient – causes
causes uterine contractions-
contractions- prenanc$
prenanc$ cateor$
B
b. most common
common cause
cause o" astric
astric ulcer
ulcer +#/ID#
+#/ID# inta0e-
inta0e- aspiri
aspirin
n
0. /nti ulcer
ulcer drus-
drus- remembe
rememberr pathoph
pathoph$sio
$siolo$
lo$
l. /ntib
/ntibiot
iotics
ics "or ).p$l
).p$lor
orii in"ec
in"ectio
tions
ns
i. Co-amo
Co-amo?ic?icla*
la* – /umen
/umentin tin
ii.
ii. ,etr
,etron
onid
ida:
a:ol
ole
e –'la
–'la$$ll
iii.
iii. Clarit
Clarithr
hrom$
om$cin
cin - macr
macroli
olides
des  PPI
PPI

ENDOCRINE SYSTEM MEDICATIONS

- Pitui
ituita
tar$
r$ lan
landd – mast
masterer lan
lands
ds
o er$ common site o" tumors
o I" with tumor- most o" the time it will be a e?cessi*e disorder
o /n$ tumor in brain !! increase ICP
o ,anaement surer$
 )$poph$sectom$ – last option
• i"etime replacement
replacement
 Problem no hormones
o /nterior
o Posterior
 O?$tocin – timulates uterine contraction
 /D) – asopressin
• ater retention or re absorption
•  2oo
 2oo much – #I/D)
#I/D) – a lot o" water
water retention
retention
o Edema5 crac0les5 )P+ –  CONGESTION
o ,anaement – Diuretics5 restrict water
o ith dilutional h$ponatremia – i*e h$pertonic solution – A4
+aCl
• Decreased – Diabetic Insipidus- DEHYDRATION
o Pol$uria and pol$dipsia
o Diluted urine
o Polidipsia does not cause the Pol$uria
o Dianostic test- fuid depri*ation test – 0apa di 0a bini$an n
water> ihi 0a parin n ihi - positi*e
o ,anaement
 Gi*e *asopressin;pitressin= 5 $pressin ;Diapid= - nasal
spra$> #F and I, in9ection
• Gi*en "or cardiac arrest- substitute "or rst line o"
dru "or C/ H Epinephrine
o /nterior
 '#)
 )
 Growth )ormone
• Growth o" bones and orans – tissues and cells
• ac0 G) – dwarsm
o ,anaement Growth hormone until epiph$sis closes up –
relati*e
 Do and B ra$ to chec0
 er$ e?pensi*e
 #omatrem – #omatropin
• E?cessi*e
E?cessi*e G)
o Giantism – epiph$sis is still open
  er$ prone to osteoarthritis – too much pressure on 9oints
o /cromeal$ – epiph$sis is close
 ones will widen
 Chanes in ph$sical appearance is permanent e*en with
medications 
 ,anaement
• DOC G) antaonist-
antaonist- Octreotide
Octreotide /cetate
/cetate
;#andostatim=-
;#andostatim=- anti-emetic dru – can be i*en with
se*ere + – underoin chemotherap$
  2#)
• !! 2h$roid lands !! 2A and 2J
• Iodine is *er$ important – li*in in mountains> oitroenics- root crops
• ith se*ere h$poth$roidism – m$?edema
• Cretinism- conenital absence o" th$roid lands
• /uto immune destruction o" th$roid lands – )ashimoto&s disease
o #2E%OID#- all auto-immune diseases5 in addition in 2)
• )$poth$roidism
)$poth$roidism – lahat mababa e*en peristalsis5
peristalsis5 cold intolerance
intolerance
o ,anaement – iodine rich "oods
 P%OOID- th$rolobulin
 e*oth$roi?ine
e*oth$roi?ine – #$nthroid-
#$nthroid- increase the meatabolic rate
o" bod$ tissues- pure "orm o" 2J
 ioth$ronine
ioth$ronine ;C$tonnel=- pure 2A
 iotri? ;Euthroid=
;Euthroid= – pure 2J and 2A J1 ration
 Dessicated th$roid e?tracts
 #E- too much #+#
• )$perth$roidism – heat intolerance5 restless5 mala0as 0umain> pa$at5
all increased
o  2h$roidectom$
 2h$roidectom$ – i" there
there is a(ectation o"
o" th$roid land-
land- tumor o"
th$roid land
o Goiter- h$po and h$perth$roidecom$
T3 and T4 are inversely r!!r"i!nal
r!!r"i!nal "#e TSH
•  2h$roid land- hihl$
hihl$ *ascular – chec0
chec0 "or bleedin-
bleedin- chec0 bac0 o" nec0
o ,a0e it small rst- uol&s solution
• /nti 2h$roid medications
o Inhibit th$roid hormone s$nthesis
PTU $r!yl"#i!%ra&%l' reven" "#e (!r)a"i!n !( TH
• SE* A+ran%l!&y"!sis $ )!ni"!r (!r si+ns and
in(e&"i!n
•  2apa:ole
 2apa:ole – methima:ole
methima:ole
o Potassium Iodide – ##KIHuol&s solution
 %educe si:e and *ascularit$ o" oran pre op
 Inhibit 2) s$nthesis
 Drin0 with straw
• 'reLuent swallowin- tonsillectom$
  2) – "or metabolism-
metabolism- #+#5 "or rowth
rowth as well
 /drenocorticotropic )ormone – "rom adrenal corte?
• /C2) !! adrenal lands
o !! corte? !! G,/
 Glucocorticoid – Cortisol and steroids – per"ormance
enhancers
 • Gluco- comes "rom lucose- ma0es lucose le*el o
up
• #teroids pro*ides lucose- /2P – ener$
• #teroids – t$pes
o 'or medicine purposes – lucocorticoids- will
not build up muscles – catabolic – brea0s
down ener$ sources – C)O+> C)O and "ats
o /nabolic steroids – builds up – "or muscle
rowth
• Cushin&s s$ndrome – secondar$ "rom ta0in
steroid "rom outside
• Cushin&s disease-
disease- e?cessi*e – tumor in pituitar$
land !! Mstimulation in G,/
o )irsutism> deeper *oice> acne – sebaceous
lands
o ith h$pernatremia5 h$ponatremia – hih K>
low na diet
o Edema> crac0les – conestion
o /drenalectom$
• ,ain hormone in adrenal corte? G- when G comes
out> ,/ "ollows
• Catabolic in nature – brea0s down
o C)O- lucose- h$perl$cemia-
h$perl$cemia- normal #E o"
steroids
o 'ats !! accumulate in areas with M #F
tissues !! abdominal areas !! TRUNCAL
O,ESITY-
  shoulder !! u(alo hump
o C)O+ !! amino acids !!
 ,uscles> most parts bod$
 ones – osteoporosis
 #0in !! collaen !! thin s0in !!
*er$ prone to stretch mar0s
 /ntibodies !! in"ection –
immunosuppressant
 ,ost abundant in blood- albumin-
decreased – shi"tin compartments-
possible in "ace !! MOON .ACIES
 ,ineralocorticoid-
,ineralocorticoid- aldosterone – water and sodium
retention
 /ndroens- se? hormones
 /ddision&s Disease
• #teroid 2herap$
o Prednisone> h$drocortisone
o %eplacement therap$ ;addison&s disease=
o /lleries>
/lleries> anti-infammator$> increased ICP>
autoimmune disorders> transplant> cancer
o SE
C%s#in+/s syndr!)e $ 0%1al!
#%) )!!n (a&e "r%n&al !0esi"y
 ede)a HPN #yerna"re)ia
#irs%"is) #yer+ly&e)ia )%s&le
as"in+
I))%n!s%resi!n
 /dminister with "ood or mil0
 %eplacement- 6HA /, o" hormones – J-
7/,5 1HAP, o" hormones – 1-3P,
 Disease %? i*e in /,
• /ddisonian crisis – sudden stoppin o" steroid
therap$
o Decrease lucose> +a
o !! medulla – epinephrine and norepinephrine
 2umor
 2umor in medulla-
medulla- pheochromoc$toma
pheochromoc$toma – increased
increased epi and
nore- M#+#
Pr!0le)* SEERE HYPERTENSION
/nti )P+ drus and #urer$
- Dia0e"es
o  2$pe
 2$pe 1- adolescents5
adolescents5 auto- immune
o  2$pe
 2$pe 6
 Insulin resistance – does not attach to the receptor
o /nti Diabetic /ents
 Insulin
• 'acilitates transports o" lucose into the cells
• /dministered #F
• ,emori:e the pea0 – $ou will ha*e h$pol$cemia- i*e "oods
• %apid actin- ispro ;humalo=
o 18-13minutes5 1 hour pea05 duration A hours
o In E,E%GE+CN #I2U/2IO+#
• #hort actin – reular
o Onset – A8 mins to 1 hour P 6-J hours5 D -7 hours
• Intermediate
Intermediate actin +P) and ente
o O 6-J hours5 P 7-16 hours5 D 16-1 hours
• on actin insulin
o Glarine ;lantus= – no pea0 insulin- 6J hour duration
 Good maintenance dru5 constant concentration o" blood
lucose
• /dministration
o )ow does insulin come in concentration unitsHml
o Can combine reular short actin and intermediate
intermediate +P)
 %eular rst to aspirate- clear
 Clear be"ore cloud$
o Can be i*en I – reular insulin5 CG monitorin
monitorin e*er$ 1 hour
• Insulin ad9usted considerin
considerin the ph$sical and emotional stresses o" a
peron
o #tress- M insulin needs
o E?ercise – decrease insulin needs
• /dminister
/dminister all insulin #F
• %otate sides o" in9ection ;1 inch awa$=
• /bdomen- "astest absorption5 "ollowed b$ arms5 do not in9ect cold
insulin ;lipod$stroph$=
• #tore in room temperature ;i" oin to use in A8 da$s= or place in re" 
 • i"espan o" insulin in room temp – 1 month – t$pe 1
• %e"- A months – more in t$pe 6
• Do not sha0e the insulin ;ubbles=
• Insulin pump
o Continuous #F insulin in"usion in*ol*es the use o" small>
e?ternall$
e?ternall$ worn de*ices that closel$ mimic the "unctionin
"unctionin o" the
normal pancreas
o Acc s$rine
o  Nou
 Nou chane the the needle e*er$ A da$s.
da$s.
o Deli*er$ s$stem
o asal –continuous dosin o" insulin
o It cannot detect h$po or h$perl$cemia
o %eLuires CG – more "reLuentl$ – A-J times a da$
• .3 to 1 inch – runner – in rotatin sites
• In9ection in #F – lipod$stroph$5 not in the insulin itsel" 
• Nou
 Nou cannot use use "or 6 -A wee0s 0apa naamit
naamit na lahat nn sites in a
limb !! abdomen
• DK/ or )++K#– blood lucose 88-788mHdl5 ) up to 1688mHdl
• DK/- t$pe 1
• ))+K# – t$pe 6 – reular I insulin
• 2he more
more stress> e?cited
e?cited and stimulated!!
stimulated!! moremore lucose !! moremore
insulin
o In"ection> sic0
o I" $ou e?ercise> 0ailanan 0umain.
 Oral antidiabetics
• %eLuire some "unctionin beta cells
• ower serum lucose in *ariet$ o" wa$s dependin on the dru
• Onl$ "or t$pe 6
o i"est$le modication !! Oral antidiabetic
• iuanides – decrease hepatic production o" lucose
• /lpha lucosidase inhibitor – bloc0s absorption o" C)O
• ,elitinide – stimulates release o" insulin "rom pancreas
• 2hia:olidinedione
 2hia:olidinedione – reduces
reduces cellular
cellular insulin resistance
resistance
o )$pol$cemia – h$perl$cemic aents
 %estlessness and Cold clamm$ s0in – rst s$mptoms
 #imple suars - conscious
• iLuid ! solild
 Unconscious
• I" with I access De?trose 384
o er$ concentrated lucose – at ris0 "or burns
o #tandin order – less than 38mHdl
o )ow much depends on when she will ets up
o I" still unconscious- 6 pac0s – call ,D
o olus – "ast push- direct I
o Goal para maisin 0aaad@
o ial in the Philippines- $ellow5 U# blue
• +o I Glucaon #FHI,
o Increase blood suar b$ stimulatin l$coenol$sis
;unconscious5
;unconscious5 home settin5 no I=

ANTI NEOPLASTIC AGENTS

'  2he cells are
are abnormal and and mutated –carcinoenic
–carcinoenic substances
substances and *iruses
' Proli"eration o" abnormal cells !! can metastasi:e
' Cell c$cle
o G8- restin phase5 cell is not doin an$thin
Cancer cells are not susceptible
susceptible to to?ic e(ects b$ chemotherap$
o G1- post mitotic phase5 preparation
En:$mes necessar$ "or D+/ s$nthesis are produced
C)O+- *er$ important
Preparation o" all inredients
o #- D+/ s$nthesis phase - methotre?ate
 D+/ s$nthesis ta0es place "rom D+/ separation to D+/ replication
 D+/- most important part o" cell
o G6 – Premitotic phase
 %+/ and speciali:ed C)O+# are made –additional inredients
o , – ,itosis – *in0a al0aloids
 Di*ided into J phases
• Prophase
• ,etaphase
• /naphase
•  2elophase
 2elophase
- Di*ide
Di*ide 0a0a n di*i
di*ide>
de> di
di 0a pa
pa 0umpl
0umpleto
eto sa inr
inredi
edient
entss
- eu0
eu0emi
emia a – increas
increasee leu0o
leu0obla
blast5
st5 *er$
*er$ prone
prone to in"
in"ect
ection
ion
- Goal
Goal sto
stopp the
the canc
cancer
er cell
cells
s
o  2o
 2o administer aents
aents in doses
doses lare enouh
enouh to eradicate
eradicate disease
disease but small enouh
enouh
to minimi:e /E
- Cell
Cell di*i
di*isio
sion
n one
one wild@
wild@ +ormal
+ormal cells
cells mutate
mutate
- Chemot
Chemother herap
ap$$ – inter"
inter"er
eres
es with
with cell
cell di*i
di*isi
sion
on
- #E
o one marrow depression
 , !! all blood cells
• +eutropenia- mature C
o /*oid "resh fowers> "ruits and *eetables
o /*oid o*ercrowded places
o imit *isitors – 6 *isitors at a time
o Dru to increase neutrophils +eupoen – #F and put in re"- do
not sha0e the bottle – destro$ the C)O+5 same as Epoen
•  2hromboc$topenia
 2hromboc$topenia
o #o"t bristled
o Electric ra:or
•  /nemia
o Gi*e Epoen- Er$thropoietin
o /lopecia
 Co*er
 /ll hair o*er the bod$
 +% secure patient that it is 9ust temporar$
o ,ucous membranes a(ected – stomatitis
 /*oid alcohol based astrinent
o +
 /nti-emetics
• Dopamine antaonist – can cause EP#
• #erotonin antaonist – #E2%O+ – DOC
o er$ e?pensi*e
 o Ele*ated Uric /cid- h$peruricemia
h$peruricemia
 $ product o" C)O+ metabolism uric acid
o ,onitor "or ele*ated K also "%)!r lysis s%ndr!)e
o /ll s$mptoms e?cept 2# – e?pected
o  2#- /E
- Drus
o /l0$latin dru
 C$clophosphamide ;c$to?an= – hemorrhaic c$stitis- increase O'I
o /ntimetabolites – stops the # phase
• ,ethotre?ate> 3'U
o /nti tumor /2
 Do?orubicin - cardioto?ic
 leom$cin- lun brosis
o ,itotic inhibitors
 incristine
 inblastine
o )ormones
 Estroens> androens> anti-estroens ;2amo?i"en=
  2umors
 2umors that are hormone dependent
dependent
• reast cancer – estroen
o Gi*e anti-estroen
anti-est roen – 2amo?i"en – 2a?ol
- /dministration
o Central line-subcla*ian *ein
 Porta cath
o Chemical burn – e?tra*asation
 #top the in"usion
 /spirate remainin dru "rom needle – do note remo*e needle rst
 ah
ah
 Ice pac0 ;"or 68minutes per hour "or 6J-J7 hours= or pour +##

ANTI,IOTICS
- ,edica
,edicatiotions
ns used
used toto treat
treat bacter
bacterial
ial in"ect
in"ection
ionss
- Cult
Cultur
uree and
and sens
sensititi*
i*it
it$
$
- Proph
Proph$la
$lacti
ctic
c therap$
therap$ ;neom
;neom$ci
$cin
n in colore
colorecta
ctall surer
surer$=
$=
- act
acter
eric
icid
idal
al – 0ill
0ill bact
bactereria
ia
- acter
acterios
iostat
tatic
ic – inhibi
inhibitt rowt
rowthh o" susce
susceptptibl
iblee bacter
bacteria
ia
- h$ with ith resis
esista
tannce
ce
o  2a0e
 2a0e antibiotics
antibiotics when not needed – *iral *iral in"ections
o  2a0e
 2a0e / in in lon time
o Did not nish duration – no s$mptom
 ,D% 2 - 2
• on treatment
• Did not nish duration
• Fuinolones
o  2a0e
 2a0e lare
lare doses o" /
 #tic0 to the lowest dose
- Gene
Generarall ad*
ad*ererse
se react
eactio
ion
n
o /lleric – h$persensiti*it$ reactions
o #uperin"ections
#uperin"ections – in"ection that sets in because normal fora was one
 +'- protects "rom some 0inds o" in"ection – "unal in"ections
 road spectrum /- 0ills both ram positi*e and neati*e microbes
 +arrow spectrum
 o Oran to?icit$
 )epatoto?ic and nephroto?ic
- Drus
o Penicillin – GI s$mptoms5 h$persenti*it$ reaction
 #a"est5 most popular and most abused
 ,an$ microbes – resistance
 Diarrhea> abdominal pain
 Pen G – DOC "or s$philis-2reponema pallidum
 eta- actam- chemical structure o" PC+
o Cephalosporin
 #ame chemical structure as PC+5 beta lactam
 ,ore prone to superin"ection
 Possible "or cross resistance5 cross aller$ – PC+
 CE' or KE'
 road spectrum
 )aban tumataas> mas broad spectrum – le*els o" enerations
o  2etrac$lcine
 2etrac$lcine – $ellow
$ellow teeth5 $ellow
$ellow sunQ
sunQ
  Nellowish
 Nellowish discoloration
discoloration o" teeth ; do not use "or last hal" o" prenanc$
prenanc$ till 7
$ears o" ae=
 Photosensiti*e
 Do not i*e until permanent teeth has erupted
 Do not i*e with children – stron aRnit$ with calcium
o /minol$coside
 +ephroto?ic
 Ototo?ic ;7th C+=
• /coustic ner*e
• )earin and balance
•  2innitus
 2innitus and *ertio
 Gentam$cin
 #treptom$cin
  2obram$cin
 2obram$cin
 +eom$cin
 ,NCI+
o Fuinolones
 C$stalluria – cr$stalli:ation in the urine – bladder – stones
• MO'I
 Photosensiti*it$
 'OB/CI+
 'or U2I and %2I
 Ciprofo?acin- Ciproba$
 /ccordin
/ccordin to DO) – ,D% 2 – alternati*e to %IPE#- Luinolones
o ,acrolides
 GI irritant
  2a0e
 2a0e with "ood
 Er$throm$cin- ta0e "or 1J da$s
 /:ithrom$cin
/:ithrom$cin – a:ithroma? – i*e OD dru "or A da$s – "or P+, – C/P
o ancom$cin
 %ed man s$ndrome
• Causes *asodilation
• %edness
• )$potension when in"used too "ast
• %ed nec0 s$ndrome – sin start "rom nec0
 • %eason in"usion o" too "ast
 DOC ,%#/ in"ection
• Common nosocomial in"ection
 DOC Clostridium diRcile – diarrhea – most common nosocomial in"ection
o #ul"onamides
 Cr$talluria
 Photosensiti*it$
 #te*en Sohnson #$ndrome – s0in condition – as i" the$ ha*e second deree
burns
 Oldest drus – all with sul"a
 Cotrimo?a:ole
 'or U2I and %2I
 DOC "or s0in in"ections – "or burn in9ur$
 #il*er #ul"adie:ine
#ul"adie:ine
 #il*er +itrate

ANTITU,ERCULAR DRUGS
- #ide E(ects
o %
hepatoto?ic
discoloration o" all secretions
o I+)
Peripheral neuritis ;bloc0s *itamin =
)epatoto?icit$
er$ prone – onl$ A months
o P</- hepatoto?icit$
o Ethambutol
lindness – optic ner*e damae
o ,$rin – I+)  %i"ampicin P</
o ,$rin 'orte T I+)  %i"ampicin  P</  Ethambutol
o AOID ALCOHOL
o %IP – hepatoto?ic – li*er en:$mes

ANTI.UNGAL MEDICATION
- /mphoter
/mphotericin
icin - DOC
DOC "or s$stemic
s$stemic "unal
"unal in"ec
in"ection
tions-
s- blood
blood in"ectio
in"ections
ns
o #ha0e and ba0e – chills and "e*er – normal #E
- +$statin
o /dministered orall$ or topicall$ to treat candidal in"ection
 aina or mouth5 s0in
 aina – chees$ li0e drainae "rom *aina- $east in"ection
• ainal tablet or suppositor$
o #wish and swallow or swish and spit
o #uspensions>
#uspensions> powder> cream> ointment> *ainal tablets
 Oral – oral thrush – white patches – suspension5 attachment
 #wallow- astric
o 'unal in"ections common in moist areas – powder> cream or ointments
- Imida:ole
o Ketocona:ole ;+i:oral=
o ,icona:ole
o Clotrima:ole
o 'lucona:ole ;Difucan=
o DOC "or rinworm
   2inea corporis-
corporis- bod$
 Capitis – head
 Pedis – "eet

ANTIIRAL MEDICATIONS
- /ll ne
nephroto?ic
- /c$clo*ir – #o
#o*ira?

HYPERURICEMIA
- Reas!ns*
o Purine rich "oods
o De"ecti*e uric acid ! accumulation o" uric acid !
Kidne$ stones


 Soints


 2ophi
 2ophi – uric acid deposition
• deposition
•Gout$ arthritis – infammation
o DOC too much pain – Colchicine
o Uric acid s$nthesis inhibitor – /llopurinol – <$loprim
o Uricosurics – Probenecid ;enemid= – taatanal n U/
o /E +ephroto?ic- increase O'I

ANALGESICS
- +ar
+arcoti
coticc and
and non
non narc
narcot
otic
ic ana
anal
les
esic
ics
s
- Opio
Opiodd – pur
pure "or
"orm
m ,orp
,orphihine
ne
o #$nthetic- Demerol
o Codeine
o +arcotic
 /lter perception o" and response to pain
 Decrease #> alertness> couh and peristalsis
 Constrict pupils
 /ddicti*e
o ,orphine sul"ate
 E(ecti*e "or acute pain due to /,I> cancer> post op pain
 ,onitor "or %%
 /ntidote +alo?one ;narcan=
 Do not i*e in cholec$stitis – can cause spasm o" the sphincter o" Oddi
• Instead i*e Demerol- meperidine5 i" anti spasmodic is not a*ailable
"rom choices- cholec$stitis
Give in an&rea"i"is 555
o ,eperidine – Demerol
 #horter actin
 #$nthetic opiate aonist
 Post op pain5 prenanc$
 +euroto?ic – con"usion in elderl$
 Elederl$ – neuroto?icit$ can result
 DOC in and cholec$stitis
- +on narcot
narcotic-
ic- stops
stops prost
prostal
aland
andin
in s$nt
s$nthes
hesis
is
o #alic$lates- most e(ect o" all
 %educes
%educes pain> "e*er> anti-infammator$> anti-platelet
 Causes bleedin> GI irritation> ototo?ic ;7 th C+=
 Don&t i*e to children $ouner than 16 $ears old with fu li0e or *iral
s$mptoms
 • %e$e&s #$ndrome – *omitin and lethar$ and coma
o +#/ID#
 +o anti platelet
 Gastric irritants5 hepato?ic and nephroto?ic
 ,e"enamic acid> ibupro"en and 0etorolac> toradol
 COB II inhibitors
• COBI – Celeco?ib – less astric irritation
o /cetaminophen
/cetaminophen or paracetamol
 /cetaminophen
/cetaminophen – no anti infammator$
 )epatoto?ic
 ,a? dose J per da$
 /ntidote /cet$lc$steine – ,ucom$st
 +eo aspilet or +eo 0idilet – paracetamol
 east e(ect than others

CNS STIMULANTS
' Uppers
' ,etamphetamine- shabu
' #+# and C+# - M#> h$perl$cemia
' /mphetamines – adderall
' Ca(eine- *i*arin
' De?troamphetamine- De?edrine
' ,eth$lphenidate
,eth$lphenidate – %italin – /D)D- more "ocus and concentrated
o Parado?ical – opposite5 rela?ation
' Indications
o +arcoleps$
o /D)D
o /ppetite control
o O0esi"y – direct e(ect on h$pothalamus- depress appetite center- e(ects are
temporar$
o Reversal !( resira"!ry dis"ress
- E(ects
o Insomnia> restlessness> irritabilit$> )P+> tach$cardia> dru dependence and
tolerance
o Ceilin e(ect – dru tolerance
- +%
o /nore?iant e(ect are temporar$
o  2o
 2o a*oid insomnia>
insomnia> ta0e  hours be"ore
be"ore bed time
o Do not abruptl$ withdraw the dru – withdrawal s$mptoms
o /ssess P and pulse durin treatment
o /nti )P+ and anti diabetic doses ma$ need to be ad9usted

CNSDEPRESSANTS
- #edati
#edati*es
*es-- rela
rela?5
?5 most
mostl$
l$ use
usedd duri
durin
n da$ time
time
- )$pnosis – sleep
- General #E
o %esidual drowsiness ;hano*er=
o Dru dependence
o Dru tolerance
o ithdrawal s$mptoms
- /lcohol
- #-)
#-) !
!!
! ""or
or sei:
sei:ur
ure5
e5 ant
antii con
con*u
*uls
lsan
ants
ts
o arbiturates
  Decrease impulse transmission to the cerebral corte?
 Used "or epileps$ and sei:ures> insomnia and sedation
 Cateories
• Ultra short
o  2hiam$lal> thiopental
thiopental +a – anesthesia
anesthesia
• #hort
o Pentobarbital> secobarbital
• on - sei:ures
o Phenobarbital – uminal – "or epileps$
o en:odia:epines
 ,ost "reLuentl$ prescribed sedati*e- h$pnotics5 an?iol$tics
• Used also as ad9unct "or sei:ure acti*it$
• %elie" o" delirium tremens – alcohol withdrawal
• Dia:epam – *alium
• ora:epam – ati*an
• ,ida:olam – Dormicum
 Grand mal sei:ures-
sei:ures- Phenobarbital5
Phenobarbital5 ben:odia:epines
ben:odia:epines
• Unconscious
 /bsence sei:ure-
sei:ure- can be 188? per da$5 common in J-16 $ears old-
old- DOC
ben:odia:epines
• /wa0e and conscious> unaware5 tulala
 #tatus epilepticus – one sei:ure a"ter the other- suunod sunod5 a"ter stoppin
o" anti con*ulsants5 DOC DI/<EP/,- *alium per I
  2herapeutic uses
uses
• #edation5 sleep induction
• #0eletal muscle rela?ation
• /n?iet$ relie"5 aitation> panic disorders
• Epileps$
• /nesthesia

ANTI CONULSANTS
- arb
arbit
itur
urat
ates
es-- Ph
Phen
enob
obar
arbi
bita
tall
- Phen
hen$to
$toin –Dil
Dilant
antin
o #E drowsiness> sedati*e> di::iness> h$potension> leucopenia> GI+GI/
)NPE%P/#I/ ;Dilantin=5 teratoenic
o /ssess sei:ure acti*it$
o /ssess oral mucous membranes
o I- mi? with +#l not with de?trose- precipitate
o ,onitor phen$toin le*el – 18-68 microramsHml
o Urine ma$ turn pin0
o +C "or G)
 Oral care
 ,assae the ums