PHARMACOLOGY

Transcribed by: Ashley Empaynado | BS Nursing | Prof. Mikhail Cenon

LECTURE NOTES ! o Oral flucytosine (the reason why this is the

ANTIFUNGAL DRUGS
Antifungal drugs or also known as “antimycotic
drugs,” when we say mycosis it means a fungal
infection.
last line drug, it’s because of its adverse
reaction, specifically sa liver)
 Intertriginous (usually sa moist spot, sa mga
liblib (armpits))
 Topical nystatin

Clinical Use of Antifungal Medications

 Candidiasis
o Causative Agent: Candida Albicans (isa
siyang uri ng fungi at kasama sa normal flora
ng katawan natin, although the problem is
kapag nag-grow siya lumipat sa iba’t ibang
location).
o Treatment depends on the location of
infection
o Treatments:  Treatments
 Oropharyngeal (fungal infection sa bibig)  Systemic/Invasive (bihirang mag karoon ng
 Local Drugs: ganito at tinatawag silang opportunistic
o Topical Nystatin pathogen kasi nagt-take advantage sila sa
immunocompromised patients)
- Swish + Swallow (imumog bago
 Example; sa mga cancer patients na nagt-
lununin)
take ng chemotherapy mahina immune
o Clotrimazole Lozenge (it looks like a
system nila so pwedeng mag take advantage
candy medication, like strepsils or
yung candidiasis, or mga patient na may
dequadin lozenges)
AIDS possible for systemic candidiasis.
 Esophageal (fungal infection sa
 Another Example; sa broad spectrum
esophagus)
antibiotics, ang nangyayari naturally our
 Sytemic Drugs:
body contains good bacteria which restrains
o Oral fluconazole
candidiasis to spread but if you are taking
o Oral ltraconazole (alternative drug)
broad spectrum antibiotics; nagiging prone
ka sa fungal infection since napapatay ng
broad spectrum antibiotics ang mga good
bacteria na pumipigil sa candidiasis.
o Oral fluconazole
o IV Amphotericin B (last resort); a broad
spectrum antifungal. Lahat ng klase ng
fungi kaya niyang patayin but ang bad side
niya is sobrang dami niyang side effects.
- That’s why ang bansag sakanya
Amphoterrible B.
 Treatments
 Aspergillus/Aspergillosis
 Vulvovaginal
 Causative Agent: Aspergillus flavus
o First line: (may mga vaginal creams na
 Involves the lungs; known as “farmer’s lung”
pinapahid sa loob ng vagina)
 May cause “fungal balls,” in the lungs called
o Topical Miconazole
aspergilloma; nagkakaroon ng detrimental
o Topical Clotrimazole effects.
o Second line:  Treatments:
o Oral fluconazole o Voriconazole
o Third line: o Amphotericin B (last resort)
 PHARMACOLOGY
Transcribed by: Ashley Empaynado | BS Nursing | Prof. Mikhail Cenon

o Amphotericin B (last resort); for severe

cases.

 Cryptococcus
 They are the same as the Aspergillus na sa
lungs tumatama; but ang difference nila
pwedeng ang Cryptococcus ay pumasok sa  Tinea Infections
Central Nervous System, tumagos sa spinal  AKA ringworm (although walang actual
cord hanggang sa kumalat sa brain and mag helminths/worm na involve)
cause ng meningitis.  Causative Agents:
 Causative Agent: Cryptococcus neoformans o T. capitis (head)
 Involves the lungs but can spread to o T. corposis (body)
meninges causing cryptococcal o T. cruris (groin); fungal infections sa groin
meningitis. ay jock itch.
 Treatments: o T. pedis (foot)
o First 2 weeks o T. unguium (nails)
o Amphotericin B + Flucytosine (kasi  Treatment:
kailangan mapatay agad)  First line treatment
o Maintenance therapy o Topicals
o Fluconazole only  Miconazole
 Clotrimazole
 Ketoconazole
 Last line
 Griseofulvin
 Treatment for fungal infections in nails (T.
unguium)
 Terbinafine

 Blastomycosis, Histoplasmosis,
Coccidiomycosis
 They could also infect the lungs.
 May cause pneumonia, meningitis or skin
lesions.
 Treatments:
o Itraconazole (preferred) Notable Adverse Effects
o Fluconazole  Amphotericin B
 ROA: IV
 PHARMACOLOGY
Transcribed by: Ashley Empaynado | BS Nursing | Prof. Mikhail Cenon

 Nephrotoxicity o Increased breast tissue in men

 Other nephrotoxic drugs are o This is specific to oral ketoconazole.
aminoglycosides, NSAIDs, cyclosporine and  Hypokalemia
so on. o Low K levels leading to torsades de pointes
o Kidney toxicity  Monitor K levels and administer K
o Monitor kidney function supplements if needed
 Adjust kidney function  Terbinafine
 Phlebitis  Hepatotoxicity
o Inflammation of the vein o Liver toxicity
 Rotate infusion site  Monitor SGPT/SGOT
 Fevers & Chills during infusion  Dysgeusia
o Give paracetamol and diphenhydramine o Loss of taste
as prophylaxis  Griseofulvin
 Anemia  Hepatotoxicity
o Monitor hematocrit levels closely o Liver toxicity
 Hypokalemia  Monitor SGPT/SGOT
 Means low potassium (K) levels  CYP Enzyme Inducer
 Low K levels leading to torsades de  Tinataas niya yung levels of CYP Enzyme sa
pointes (a very fatal cardiac arrhythmia) loob ng katawan; and CYP Enzyme and
 What happens here is; our potassium & responsible for metabolizing drugs. Bumibilis
sodium is very essential to our heart yung metabolism ng drugs, mabilis
rhythm which we call as ‘sodium- lumalabas sa katawan yung drugs.
potassium pump’ that regulates our o Lowers concentration of drugs in the body
heartbeat, so if magka-imbalance mag especially birth control pills
kakaroon ng torsades de pointes.  Advise patients on birth control that there
 Monitor K levels and administer K may be lower efficacy when on
supplements if needed; (preferably oral griseofulvin
para mabagal ang pag dating sa blood  Teratogenic & Carcinogenic
stream kasi pag binigay ang potassium  Teratogenic means cause birth defects.
supplements as IV bolus; literal na o Do NOT give to pregnant women
mapapatay ang pasyente pag ganon  Disulfiram Reaction
ibinigay). o Nausea, vomiting, flushing (pamumula), and
 Oral azole antifungals hypotension (lower blood pressure) when
 Hepatotoxicity taken with alcohol.
o Monitor SGPT/SGOT (indicators ng liver  Flucytosine
function)  Teratogenic
 CYP Enzyme Inhibitor o Do NOT give to pregnant patients.
 It means iniinhibit niya yung metabolism ng  Bone marrow suppression
other drugs; sa Pharmacokinetics, o Lowers production of WBC & RBC
metabolism is essential to wash away the  Conduct complete blood counts
drugs. Before we excrete, we need to periodically
metabolize. If we can’t metabolize, maiipon
sa loob ng dugo yung drugs, possibly, mag
PARASITOLOGY
cause ng toxicity.
Helminths: is the general term meaning worm;
o Do NOT administer oral azole antifungals
ang mga drugs kontra bulante ay called as
with any of the following:
anthelmenthics.
 Pimozide, Quinidine, Doferilide, Cisapride,
Two types of Nematodes:
Cyclosporine, Warfarin, Digoxin,
Intestinal Nematodes
Sulfonylureas (Glimepiride, Glipizide, etc).
Blood/Systemic Nematodes
 Gynecomastia
 PHARMACOLOGY
Transcribed by: Ashley Empaynado | BS Nursing | Prof. Mikhail Cenon

Intestinal Nematodes
 Ascariasis
o Ascaris lumbricoides
o Intestinal roundworm  Enterobiasis
o Infects via ingestion of eggs o Enterobius vermicularis
o New world hookworm
o Infects via ingestion of eggs

 Necatoriasis
o Necator Americanus
o New world hookworm
o Infects via skin penetration  Capillariasis
o Capillaria philippinensis (discovered in the
Philippines)
o Bagsit
 Strongyloidiasis
o Strongyloides stercoralis
o Threadworm
o Infects via skin penetration

 Trichinellosis
o Trichinella Spiralis
o Muscle roundworm
o Infects via ingestion of raw pork

o Treatment:
 Mebendazole and albendazole are the
drugs of choice for most intestinal
nematode infections EXCEPT threadworm
infections.
 Thiabendazole is the treatment of
 Trichuriasis choice for threadworm infections.
o Trichuris trichiura
o Whipworm Blood and Tissue Nematodes
o Infects via ingestion of eggs  River Blindness
o Onchocerca volvulus
 PHARMACOLOGY
Transcribed by: Ashley Empaynado | BS Nursing | Prof. Mikhail Cenon

o Transmitted via infected black flies that

breed in rivers (carrier only)
o Drug of choice: Ivermectin

 Elephantiasis
o AKA Filariasis
o Caused by either Wuchereria bancrofti or
Brugia malayi
o Transmitted via female anopheles
mosquitoes
o Drug of choice: Diethylcarbamazine or DEC

Platyhelminthes: Trematodes
 Schistosomiasis (Blood Fluke)
o AKA Katayama Fever
o Causative agents:
 Schistosoma japonicum
 Schistosoma mansoni
 Schistosoma haematobium
o Signs & Symptoms
 Fever
Platyhelminthes: Cestodes  Cough
 Tapeworm Infections  Abdominal Pain
o Taenia solium (Pork tapeworm)  Diarrhea
o Taenia saginata (Beef tapeworm)  Hepatosplenomegaly (enlarged spleen)
o Taenia asiatica (Asian tapeworm) o Emerges from snails in water
o Diphyllobothrium Latum (Fish tapeworm)  Paragonimiasis (Lung Fluke)
o Paragonimus westermani
 Largest tapeworm
 May cause B12 deficiency o Infects via ingestion of inadequately
o Hemynolepis nana (dwarf tapeworm) cooked crab
 Treatment:
o Praziquantel is used for all forms of
tapeworm.
 PHARMACOLOGY
Transcribed by: Ashley Empaynado | BS Nursing | Prof. Mikhail Cenon

o Every time you have ameobiasis or

diarrhea, nababawasan electrolytes
katawan mo; in short dehydration.
Kailangan mareplace since pwede kang
 Fasciolopsiasis (Intestinal Fluke) mamatay. Kaya pag nac-cr, after dapat
o Fasciolopsis buski uminom ng gatorade, pocari sweat or
o Largest worm that can affect humans pedialyte and so on.
o Treatments:
o All trematodes (flukes) could be treated
by Praziquantel

 Trichomonas Vaginalis
 Disease Caused
o Trichomoniasis
 Foul-smelling vaginal discharge
Summary of Drug Treatments for Helminths  Genital itching
Drug of Choice Mechanism of  Painful urination
Action  Transmission
Intestinal Mebendazole Inhibits o Sexual
Nematodes Albendazole microtubule  Treatment
except synthesis in o Metronidazole
threadworm nematodes
Depletes glucose
River blindness Ivermectin Targets GABA
receptors of
helminths thereby
causing paralysis
Elephantiasis Diethylcarbamazine Unknown
AKA Filariasis (DEC)
Tapeworms & Praziquantel Induces parasite
Flukes death by increase
membrane  Blastocystis Hominis
permeability to  Disease Caused
calcium o Blastocystis
Protozoa  Watery stool
 Entamoeba Histolytica  Abdominal pain
 Disease Caused  Excessive gas
o Amoebiasis  Anal itching
 Loose Stools  Transmission
 Stomach Cramps o Fecal-oral
 Transmission  Treatment
o Fecal-Oral route o Metronidazole
 Treatment
o Metronidazole + Oral Rehydration Salts
 PHARMACOLOGY
Transcribed by: Ashley Empaynado | BS Nursing | Prof. Mikhail Cenon

o Pyrimethamine + Sulfadoxine
o This combination is also known as
Fansidar

 Giardia Lamblia  Leishmania species

 Disease Caused  Disease Caused
o Giardiasis AKA Beaver Fever o Cutaneous
 Severe abdominal pain  Most common form
 Severe diarrhea o Mucocutaneous
 Transmission  Rare
o Fecal-oral o Systemic
 Treatment  Fatal
o Metronidazole  Transmission
o Sand flies in tropical countries
 Treatment
o Na stibogluconate

 Balantidium Coli
 Disease Caused
o Balantidiasis  Trypanosoma Brucel Gambiense
 Nausea and vomiting  Disease Caused
 Stomach cramps o African Sleeping Sickness
 Diarrhea  First stage
 Transmission  Fever
o Fecal-oral  Headache
 Pig feces  Muscle & joint pain
 Treatment  Swollen lymph nodes
o Metronidazole + Tetracycline  Second stage
 Toxoplasma Gondii  Personality changes
 Disease Caused  Extreme lethargy
o Toxoplasmosis  Sleep disturbances
o Flu-like symptoms  Transmission
 Fever o Tse-tse flies in Africa
 Headache  Treatment
 Body aches o DOC: Pentamidine
 Swollen lymph nodes o Alternative: Na stibogluconate
 Transmission
o Fecal-oral
o Cat feces
 Treatment
 PHARMACOLOGY
Transcribed by: Ashley Empaynado | BS Nursing | Prof. Mikhail Cenon

 Trypanosoma Cruzi VIROLOGY

 Disease Caused This is not frequently use because SOME virus tend
o Chagas Disease to kill themselves after staying for a long time
 Acute Stage inside our body since SOME virus are self-limiting.
 Frequently asymptomatic
 May cause fever and swelling in site of  Herpes Viridae
infection  Herpes Simplex Virus (HSV-1)
 Chronic Stage o Clinical Manifestations
 Heart arrhythmia  Gingivostomatitis (cold sores)
 Dilated heart that doesn’t pump blood  Herpetic keratitis of the eye
well  Encephalitis
 Dilated esophagus or colon o Treatment
 Transmission  No cure for HSV-1 & 2 (though
o Triatominae AKA Kissing Bug nagiging dormant rin siya)
 Treatment  Acyclovir
o DOC: Nifurtimox  Shortens symptom outbreak only and
o Alternative: Benznidazole prolongs time between outbreaks.

 Herpes Simplex Virus 2 (HSV-1)

 Plasmodium Species o Clinical Manifestations
 Disease Caused  Genital Herpes
 Malaria  Neonatal Herpes
 When you go to Palawan, you are at risk for o Treatment
Malaria, you can take Chloroquine as  No cure for HSV-1 & 2
prophylaxis (prevention).  Acyclovir
 Flu-like symptoms  Shortens symptom outbreak only and
 Diarrhea prolongs time between outbreaks.
 Rapid breathing
 Rapid heart rate
 Transmission
 Female anopheles mosquito
 Treatment
 DOC: Chloroquine
 PHARMACOLOGY
Transcribed by: Ashley Empaynado | BS Nursing | Prof. Mikhail Cenon

o Influenza A is found in animals and

humans while influenza B is found only in
humans.
 Varicella Zoster Virus (VZV) o Influenza A accounts 75% of confirmed
o Clinical Manifestations cases of seasonal influenza infections
 Chickenpox o Both can genetically change over a short
 Shingles amount of time
 Reactivation of chickenpox in adults o Both are extremely contagious through
o Treatment respiratory particles
 In healthy children (chickenpox)  Treatments
 Antihistamines (nakakatulong sa o Oseltamivir
pangangati)  Should be used <48 hours after onset
 Calamine Lotion (pangtanggal ng of symptoms to reduce severity of
rashes and itching) symptoms.
 Paracetamol o Amantadine
 In adults (Shingles)  Primarily used in Influenza A
 Acyclovir  Adverse effects include:
 Shortens severity of virus  Ataxia (the body movements is not
coordinated w each other), Livedo
Reticularis, Torsades de Pointes
o Over-the-counter medications such as:
 Phenylephrine
 Paracetamol
 Chlorphenamine
 Or any combination of the 3 drugs
(Bioflu, Neozep, Decolgen, etc).

 Epstein-Barr Virus (EBV)

o Clinical Manifestations
 Infectious mononucleosis AKA “Kissing
Disease”
o Treatment
 Rest and Fluids
Livedo Reticularis
QUICK BREAK NOTES !
 If the fever is too high, is it applicable to drink
the medication 2x?
 No, because if you double the dose on one
medication (especially if the dose is 500
milligrams of paracetamol; which
considered the max dose), ibig sabihin
natataas mo lang yung chances of toxicity
 Influenza Virus or adverse effects ng paracetamol like liver
 Also known as “the flu.” damage.
 Responsible for the annual “flu season.”  Example; you’re current intake for
 Has 4 subtypes but Influenza A and B are paracetamol is 4 hours and imagine for
most common: every hour you’re taking 1000mg of
paracetamol. Edi sa isang araw, may
6000mg kang iniinom na paracetamol when
 PHARMACOLOGY
Transcribed by: Ashley Empaynado | BS Nursing | Prof. Mikhail Cenon

ang upper limit for paracetamol intake is

4000mg a day. Pag lumagpas means
higher possibility for liver damage or/
death.
 Hepatitis B and Hepatitis C
 Causative Agent: Hepadbavirus (Hepa-B),
Flavivirus (Hepa-C)  Stages of HIV
 Symptoms: o Stage 1 – Acute HIV Infection
o Abdominal pain  Large amounts of HIV is present in the
o Dark urine blood
o Loss of appetite  Many people have flu-like symptoms
o Nausea and Vomiting  If you have flu-like symptoms and
o Weakness and Fatigue think you may have been exposed to
HIV, get tested
o Jaundice
o Stage 2 – Chronic HIV Infection AKA
 Transmission:
asymptomatic HIV Infection
o Hepa-B
 Still active and continues to reproduce
 Blood, semen, or other body fluids
in the body
o Hepa-C
 No symptoms are present but can still
 Blood transmit
 Complications: if left untreated  May progress into AIDS if left
o Liver cirrhosis untreated
o Liver failure o Stage 3 – AIDS (Acquired Immune
 Treatments Deficiency Syndome)
o Chronic Hepatitis B virus will require  Most severe stage of HIV infection
lifetime treatment  Opportunistic infections may arise (on
 Lamivudine + Alpha interferons their own they are harmless but if you
 Use Lamivudine with extreme caution immunocompromised, it-take nung
in pregnant women. mga microorganism yung compromised
o Unlike hepatitis B, hepatitis C can be immune system mo).
cured  Without treatment, people with AIDS
 Rebavirin + Alpha interferons survive for around 3 years.
 Do NOT give Ribavirin to pregnant  Drugs used in HIV Treatment
women. o Nucleoside Reverse Transcriptase
 Human Immunodeficiency Virus (HIV) Inhibitors (NRTs)
 HIV is a virus that attacks the body’s  Abacavir
immune system  Emtricitabine
o If left untreated, it may progress to  Lamivudine
acquired immune deficiency syndrome  Tenoforvir
(AIDS)  Zidovudine
 It is transmitted sexually o Non-nucleoside Reverse Transcriptase
 No cure is currently available Inhibitors (NNRITs)
o But with proper medical care, HIV can be  Doravirine
controlled  Efavirenz
 Symptoms  Etravirine
 Nevirapine
 Rilpivirine
o Entry Inhibitors
 Enfuvirtide
 Maraviroc
 PHARMACOLOGY
Transcribed by: Ashley Empaynado | BS Nursing | Prof. Mikhail Cenon

 Ibalizumab
o Protease Inhibitors
 Atazanavir
 Darunavir
 Fosamprenavir
 Ritonavir
 Tipranavir
o Integrase Inhibitors
 Dolutegravir
 Raltegravir
 Covid-19
 Causative Agent: Sars-CoV-2
 Spreadvia respiratory droplets
 Symptoms may range from mild to fatal
o Loss sense of smell, taste
o Fatigue
o Fever
o Pharyngitis
o Viral pneumonia – Acute respiratory
distress syndrome – systemic
inflammatory response syndrome –
multisystem organ failure.
 Treatment/Management
o Fever
 Paracetamol
 Ibuprofen
o Inhibitors viral replication
 Remdesivir (7k) (hindi niya napapatay
pero napapabilis yung pag wala ng
symptoms)
o Dehydration from fever
 Supportive IV Fluids
 LRS (color blue), NSS (color green),
D5LRS (color pink), D5NSS (color
yellow) (when giving IV fluids hindi
pwedeng damihan when treating
covid-19 because possible na
magkaroon ng extra fluids sa lungs).
o Treatment for systemic inflammatory
response syndrome
 Tocilizumab (50k)
 Dexamethasone
o Lung support
 Mechanical ventilation