Analgesic, Sedatives, and OPIOID ANALGESICS

Based on the specific receptors they bind

Hypnotics
to avoid their activity at the receptor, opioid
are classed as full or pure agonist, partial
•Analgesics - Are pain relievers for a
agonist, or mixed agonist-antagonists.
variety of conditions, including headaches,
analgesics diminish inflammation while
• Full agonist are the most commonly used
opioid analgesics alter pain perception in
because they can alter the perception of
the brain.
pain and they don't have ceiling to their
•Sedatives - are a sort of prescription drug
analgesic effects. Pure agonist opioids
that reduces the activity of your brain.
cannot reverse analgesia like the other
They're commonly employed to make you
classes because of the potential abuse of
feel more at ease. They also employ them
it. (Controlled substances)
as anesthetics in general. Sedatives are
• Opioids tend to cause tolerance and
restricted drugs.
physiological dependence with chronic use.
•Hypnotics - are commonly like sedatives;
• This type of analgesics should be
but they are mostly like used to treat lack of
prescribed to terminally ill patients with
sleep. These, too, are restricted drugs.
constant around the clock pain, with
additional "as needed" doses for
PAIN IN SUBJECTIVE
breakthrough pain, and dosages adjusted
- Most of the time, patients seek medical
to achieve pain relief with an acceptable
care because they can feel pain. Pain is
level of side effects.
subjective, it can be experienced only by
the individual person.
SIDE EFFECTS OF OPIOIDS
- The National Health Statistics have
•Sedation
reported that the four most commonly
•Confusion
known pain is in the lower back, neck, and
•Headache and dizziness
facial or jaw pain.
•Hypotension and Bradycardia Urinary
- Analgesics are the prescribed type of
retention
medicine, contraring types of pain.
•Sexual Dysfunction
•Nausea and vomiting
PAIN HAS BOTH PSYCHOLOGICAL AND
•Respiratory and/or emotional dependence;
PHYSIOLOGICAL COMPONENTS
tolerance
•Blurred vision
- Some people have higher pain tolerance
•Seizures with large doses
than others because of conditioning, ethnic
•Rash and pruritus
background, sensitivity and/or physiological
factors. (Depending on the amount of
Precautions with opioids apply to:
endorphins released, and releasing
endorphins may cause placebo effect.)
•Head injury
•Cardiac Disease
Endorphins are endogenous analgesics
•CNS Depression (central nervous system
that the body produces in response to
depression)
extreme pain or excessive exercise.
•GI, hepatic, renal, and thyroid diseases
•Chronic obstructive pulmonary disease Nonopioid Analgesic
•Asthma •Nonopioid are given for the purposes of
relieving mild to moderate pain, fever, and
Interactions include potentiation of the anti- inflammatory conditions, for example
effects of opioids with CNS arthritis. This group of analgesics is also
depressants, including: used as coanalgesic in severe acute or
chronic pain requiring opioids.
•Psychotropics
•Alcohol
•Sedatives and hypnotics
•Muscle relaxants
•Antihistamines
•Antiemetic
•Antihypertensives

TRAMADOL
• Tramadol (Ultram) - is a centrally acting
synthetic analog of codeine with a dual
mechanism action. It produces analgesia
by weak inhibition of norepinephrine and
serotonin reuptake and is an opioid SALICYLATES AND OTHER NSAIDs
receptor agonist.
Salicylates analgesic and anti-
inflammatory actions are associated
primarily with preventing the formation of
prostaglandins and the subsequent
inflammatory response prostaglandins
help to induce.

SIDE EFFECT OF SALICYLATES AND

OTHER NSAIDs ESPECIALLY WITH
PROLONGED USE AND/OR HIGH DOSAGE

•prolonged bleeding time

•Bleeding and frequent bruising
•Gastric distress, ulceration, and bleeding
(which may be silent)
•Tinnitus (Ringing or roaring in the ears)
and hearing loss with overdose hepatic
dysfunction renal insufficiency, decrease
urine output with sodium and water
retention and renal failure
•Coma, respiratory failure especially for
children.
•Gastrointestinal (G) symptoms, which can
be minimized by administration with food
or milk or by using an aspirin buffered with • Anti-infective resistance is caused
antacids. by many factors. Therefore, the
strategies needed to combat the
ACETAMINOPHEN problem are also complex.
Acetaminophen (Tylenol) – is used RESISTANCE (Organisms)
extensively in the treatment of mild to
moderate pain and fever. It has very little • Staphylococcus aureus (MRSA)
effect on inflammation, however, • Strains of Enterococci
acetaminophen has fever adverse side • Strains of type A influenza
effects than salicylates. • Mycobacterium tuberculosis
SIDE EFFECTS OF ACETAMINOPHEN SELECTION OF ANTI-INFECTIVE
DRUGS
• Severe liver toxicity
• Renal insufficiency (decrease urine • Site of infection
output) • Status of hepatic and/or renal
• Rash or urticaria function
• Blood dyscaria • Age
• Pregnancy or lactation
• Likelihood of organisms
ANTI-INFECTIVE DRUGS development resistance
• Known allergy to the anti-infective
Are medicines that work to prevent or treat
drug
infections.
ADVERSE REACTIONS
SUBCLASSIFICATIONS
1. ALLERGIC HYPERSENSITIVITY
Antibiotics Antifungal
Aminoglycosides Antituberculosis • Rash, urticaria, mild fever
agents anaphylaxis, dyspnea, chest
Cephalosporins Miscellaneous anti- contractions, shock, collapse.
infections 2. DIRECT TOXICITY
Macrolides Agents for VRE • Ototoxicity, nephrotoxicity,
Penicilins Sulfonamides hepatoxicity, bloods dyscrasias,
Carbapenems Urinary anti- phlebitis, phototoxicity.
infectives 3. INDIRECT TOXICITY, OR
Quinolones Antivirals SUPERINFECTIONS
Tetracyclines Treatment for HIV- • New infection
AIDS infection • Diarrhea, vaginitis, glossitis
VACCINES (or Immunizations)
RESISTANCE
• Vaccines mimic the virus or bacteria
More than 70% that cause HAIs are that cause disease and trigger the
resistant to at least one drug. body’s creation of antibodies.
• Organism build up resistance to drug • These antibodies will provide
that have been used to frequently or protection once a person is infected
improperly, and then the drugs are with the actual disease-causing virus
no longer effective. or bacteria.
ANTIBIOTICS
(Penicilins Macrolides, etc.)
• Refers to large spectrum of
medicines that are useful for treating
and preventing infections caused by
bacteria.
• These types of medications have no
effect on viral, fungal or other types
of infections. Use without proper
indication can lead to resistance.
That is why antibiotics should not be
used for treatment of the common
cold, because it is a viral infection.
Contraindications
• Tinnitus, vertigo, and high-frequency
hearing loss
• Reduced renal functions
• Dehydration
• Pregnant and nursing women
• Infants or older adults
Drugs interactions
• Other ototoxic drugs
• General anesthetics or
neuromuscular blocking agents
• Antiemetics

Aminoglycosides Cephalosporins (related to penicilins)

Mechanism of action Mechanism of action

• Inhibits protein synthesis in the cell • Semisynthetic beta-lactam

wall, which results in bacterial death. antibiotics produced from certain
species of a fungus
Indications
Indications
To treat:
To treat different infections of:
• Infective endocarditis
• Sepsis • Respiratory tract
• Complicated intraabdominal • Skin
infections • Urinary tract
• Complicates genitourinary infections • Bones and joints
• Some STIs
Representative drugs
• Endocarditis
• Gentamicin Representative drugs
• Amikacin
• Tobramycin • 1st gen: cephalexin, cefazolin
• Neomycin • 2nd gen: cefaclor, cefuroxime
• Streptomycin • 3rd gen: ceftriaxone, ceftazidime,
cefdinir
Adverse effects • 4th gen: cefepime
• Nephrotoxicity • 5th gen: ceftaroline
• Ototoxicity Adverse effects
• Neuromuscular blockade
• CNS symptoms (headache, tremor, • Hypersensitivity
lethargy, numbers, seizures) • Blood dyscrasias
• Blurred vision, rash, or urticaria • Nausea, vomiting, and diarrhea
• Phlebitis with IV administration and
pain at the site of IM injection
• Respiratory distress • Benzodiazepines
• Seizures • Warfarin
• Digoxin
Drug interactions
• Statins
• Increased effectiveness with • Calcium channel blockers
probenecid • Antiarrhythmic agents
• Disulfiram-like reaction (flushing, • Azole antifungals
tachycardia, shock) with alcohol • Quinolones
ingestion and cefotetan
Penicilins
Macrolides
Mechanism of action
Mechanism of action
• Beta-lactam antibiotics produced
• Inhibit RNA protein synthesis and from certain species of a fungus. It is
suppress reproduction of the used in many streptococcal and
bacteria some staphylococcal and
meningococcal infection
Indications
Indications
Treatment of:
Treatment of
• Respiratory tract infections
• Skin conditions (acne) • Syphilis
• STI (if allergic to penicillin) • Used prophylactically to prevent
recurrences of rheumatic fever
Representative drugs
Representative drugs
• Erythromycin
• Roxithromycin • Amoxicillin
• Azithromycin • Ampicillin
• Clarithromycin • Penicillin VK
• Penicillin G
Adverse effect
Adverse effect
• Anorexia, nausea, vomiting,
diarrhea, cramps • Hypersensitivity
• Urticaria • Super infections (especially with oral
• Superinfections ampicillin) and pseudomembranous
colitis
Contraindications
• Nausea, vomiting, and diarrhea
• Liver dysfunction and GI disease • Blood dyscrasias
• Electrocyte • Renal and hepatic disorder (rare)
• Certain cardiovascular disease • CNS effect, example confusion,
anxiety, and seizures.
Drug interactions
Contraindications
• Carbamazepine
• Cyclosporine • History of serious allergy to
• Theophylline penicillins or other beta-lactams
Drug interactions Quinolones

• Potentiation of penicillin with Mechanism of actions

probenecid
• Helps treating many different
• Antagonistic effect (delayed
infections.
absorption) of oral penicillin when
• Should be reserved for infections
given antacids or with food
that require therapy with
• Antagonistic effect of some other
fluoroquinolones such as
anti-infectives on penicillin.
Pseudomonas infection or when a
Carbapenems patient is allergic to other antibiotics

Mechanism of action Indications

• Inhibit bacterial cell growth that • Urinary test

eventually kills the bacteria. • Sinuses
• Lower respiratory tract
Indications
• GI tract
Treatment of: • Skin
• Bones, and joints
• Pneumonia
• Gonorrhea
• Febrile neutropenia
• Intra-abdominal infections Representative drugs
• Diabetic foot infections
• Ciprofloxacin
• Significant polymicrobial infections
• Levofloxacin
Representative drugs • Moxifloxacin

• Meropenem Adverse effects

• Doripenem
• Nausea, vomiting, diarrhea,
• Ertapenem
abdominal pain, and colitis
Adverse effect (especially older adult px.)
• CNS effect – headache, dizziness,
• Injection site reactions confusion, irritability, seizures, and
• Diarrhea anxiety.
• Nausea • Superinfection hypersensitivity
• Vomiting reaction (rare)
• Skin rash • Phototoxicity
• Pruritus
Contraindications
Contraindications
• Older adults, especially with GI
• Colitis disease or arteriosclerosis
• Renal dysfunction • Children or adolescents
• CNS disorders • Doing strenuous exercise
• Hemodialysis • Pregnancy or lactation
Drugs interactions • Seizures disorders
• Cardiac disease
• Valproic acid
 Drug interactions
• Theophylline (ciprofloxacin)
• Warfarin
• Antacids and other preparations
containing Fe, Mg, Zn, Ca.
• Sucralfate (Carafate)
Tetracyclines
Mechanism of actions
Drug interactions
• Interferes with the ability of the
bacteria to produce certain vital
proteins for bacterial growth.
Indications
Treatment of some infection disease
caused by:
• Rickettsia
• Chlamydia
• Some uncommon bacteria
• Rocky mountain spotted fever
• Atypical pneumonia
• Some STIs
• Severe inflammatory acne
Representative drugs
• Allergic hyposensitivity (rare)
Contraindications
• Pregnancy and lactation
• Children under age 8 years
• Patients exposed to direct sunlight
• Liver or GI disease
• Renal disease (doxycycline
preferred)
• Antacids, calcium supplements, or
magnesium laxatives
• Iron preparations and zinc
• Antidiarrheal agents containing
kaolin, pectin, bismuth
• Dairy products
• Oral contraceptives
Antifungals (Fluconazole, Micafungin,
etc.)
• Used to treat specific susceptible
fungal disease
Amphotericin B

• Doxycycline Mechanism of Action

• Tigecycline
• Administered IV for the treatment of
• Minocycline
severe systematic, potentially fatal
Adverse effects infections caused by susceptible
fungi including candida.
• Nausea, vomiting, and diarrhea
• Superinfections (vaginitis and Indications
stomatitis) Treatment severe fungal infections
• Photosensitivity, with exaggerated resulting from:
sunburn
• Discolored teeth (fetus and young • Immunosuppressive therapy
children) • Patients with AIDS
• Retarded bone growth (fetus and • Severe illness
young children)
Adverse effects
• Hepatic or renal toxicity
• CNS symptoms: vertigo and cerebral • Headache
edema • Chills
• Thrombophlebitis • Fever
• Hypotension • Dizziness
• Tachypnea • Headache
• Malaise
Drug interactions
• Muscle and joint pain, and weakness
• Anorexia • Warfarin (Increased prothrombin
• Nausea time could cause hemorrhage)
• Vomiting • Oral antidiabetic agents
• Cramps (hypoglycemia can result)
• Nephrotoxicity • Rifampin (can lead to clinical failure
• Hypokalemia and hypomagnesemia of fluconazole)
• Statins (increased risk of myopathy;
Drug interactions except pravastatin)
• Lipid-based product (abelcet) • Benzodiazepines (increased CNS
increases the tolerability of the drug effect)
without compromising its antifungal Micafungin (mycamine)
effect.
• Belongs to one of the newer classes
Fluconazole
of antifungals.
• One of the most widely prescribe Mechanism of action
antifungal agents
• Given IV that provide new treatment
Mechanism of actions
options against candida and
• Acts against many fungal pathogens aspergillus
including candida without serious Indications
toxicity of amphotericin B
Treatment of:
Indications
• Esophageal candidiasis
Treatment of:
• Candidemia
• Oropharyngeal and esophageal • For stem cell transplantation
candidiasis prophylaxis
• Serious systemic candida infections
Adverse effects
(e.g., urinary tract and blood stream
infections) • Headaches and fever
• Nausea, vomiting and diarrhea
Contraindications
• Infusion reaction
• Pregnant or nursing women • Neutropenia
• Hepatic or renal disease • Hypokalemia and hypomagnesemia
Adverse effects Contraindications

• Moderate nausea • Patients under 18 years old

• Vomiting • Pregnancy and breast-feeding
• Abdominal pain • Liver dysfunction
• Diarrhea • Renal disease
• Hepatic abnormalities
Drug interactions Isoniazid (H or INH)

• There are no major drug interactions Mechanism of action

Nystatin • Inhibits the synthesis of mycolic

acids, an essential component of the
Mechanism of action
bacterial cell wall.
• Structurally related to amphotericin Adverse effects
B
• Nausea, vomiting, diarrhea
Indications
• Dizziness, blurred vision, headache,
Treatment: and fatigue
• Numbness and weakness of
• oral cavity candidiasis extremities
used as: • Hepatic toxicity

• fungicide in the topical treatment of Contraindications

skin and mucous membrane (mouth, • Chronic liver disease or alcoholics
or vagina)
• Impaired renal functions
Adverse effects • Hepatic toxicity (children’s dosage
should be limited to 10-15 mg/kg,
• Side effects are rare but may respectively)
occasionally include nausea,
vomiting, and diarrhea with high oral Indications
done.
• Potentiation by phenytoin
Drug interactions • Increase risk of hepatotoxicity w/
rifampin.
• No significant drug interactions • Alcohol
because of its lack of absorption • Antacids
from the gut.
Rifampin
Antituberculosis (ethambutol,
isoniazid, etc.) Mechanism of action

• Tuberculosis (tb) is caused by a • Inhibits bacterial RNA polymerase,

bacterium called Myobacterium
tuberculosis, which primarily attacks
the lungs.
These drugs are administered to:
1. Treat latent or asymptomatic
infection
2. Treat active clinical tuberculosis and
prevent relapse
the enzyme responsible for DNA
transcription.
Adverse effects
• Nausea, vomiting, diarrhea
• Dizziness, blurred vision, headache,
and fatigue
• Numbness and weakness of
extremities
• Hepatic toxicity
• Body fluids colored red-orange
 • Hypersensitivity reaction, with flu-like Pyrazinamide (Z or PZA)
symptoms
Mechanism of actions
Contraindications
• Converts a special enzyme to an
• Chronic liver disease or alcoholics active form which inhibits the
• Impaired renal functions synthesis of fatty acids
• Hepatic toxicity (children’s dosage
Adverse effects
should be limited to 10-15 mg/kg,
respectively) • Hepatic toxicity
• Gout
Ethambutol (E or EMB)
• Hypersensitivity
Mechanism of action • GI disturbance
• Inhibits the arabinosyltransferases, Contraindications
preventing formation of the cell wall
components arabinogalactan and • Patient with history of gout
lipoarabinomannan, and preventing • Dizziness
cell division. • Severe hepatic disease or
alcoholism
Adverse effect • Children (potential toxicity)
• Optic neuritis • Pregnant or nursing women
• Dermatitis Streptomycin
• Pruritus
• Headache Mechanism of action
• Malaise • Inhibits protein synthesis and causes
• Ever the death of microbial cells
• Confusion
• Joint pain Adverse effects
• GI symptoms • Ototoxicity
• Occasional peripheral neuritis • nephrotoxicity
Contraindications

• Visual testing before and during

therapy
• Impaired renal function
• Diabetes
• Ocular defects
• Children under 1-3
• Pregnancy (caution)
• Patients with gout