Pharmacology Review - Cloud Object Storage · Sulfonamide Drugs (Sulfa Drugs) Pre-date Pennicillins...
Transcript of Pharmacology Review - Cloud Object Storage · Sulfonamide Drugs (Sulfa Drugs) Pre-date Pennicillins...
Five Rights of Drug Administration THE RIGHT:
1. Patient
2. Drug
3. Dose The original Five Rights
4. Route
5. Time
6. Documentation
Miss any one or more of the above and you have
made a “medication error”
Characteristics of Vitamins
Fat-soluble vitamins are A, D, E, and K.
OR
Water-soluble vitamins are B vitamins, folic acid, and vitamin C.
Citrus fruits are rich in Vitamin C.
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Minerals
Iron Calcium and phosphorus
Potassium Extremely irritating to veins and fatal if given by
intravenous push method
Sulfonamide Drugs (Sulfa Drugs) Pre-date Pennicillins
Used to treat Urinary Tract Infections & Malaria
Bactrim or Bactrim DS
drink high volume of fluids to keep urine dilute. Sulfonamides crystallize in the urine and deposit in the kidneys causing pain.
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Antibiotic Agents
Broad-spectrum antibiotic agents are effective against many microorganisms.
Narrow-spectrum antibiotic agents are effective against only a few microorganisms.
Allergic reactions to antibiotic agents are common; repeated exposure may cause a mild rash or severe or even fatal reactions.
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Antibiotic Agents
Antibiotic agents are placed in broad groups:
penicillin agents (Allergic reactions are common)
cephalosporin agents
tetracycline agents
macrolide agents,
quinolone agents.
General toxicity and side effects are as follows:
Allergy
Abdominal cramping and diarrhea
Rashes
Monilia overgrowth; vaginal, perineal, or oral thrush infections result
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Antifungal Agents
Do not mix “p.o.” antifungal meds with alcohol = nausea vomiting.
Infections may be simple, as in athlete’s foot fungal rash or thrush.
In patients with impaired immune systems, fungal infections can be life threatening.
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Antiviral Agents Treats viral infections such as hepatitis, AIDS, Herpes, Flu
Interferon alfa-2b is used to treat hepatitis B, C, D, and West Nile virus
Herpes virus Drugs (topical or systemic)
Acycylovir
Famcylovir
Valacylovir
Pencylovir
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Antiparasitic Agents Lice
Lindane (Kwell) – for head lice or full body scabies
Scabies Permethrin – (Nix) for scabies
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Allergic Reactions Anaphylaxis – Severe allergic reaction and is life
threatening.
Medical emergency (ABCs)
Administer epinephrine
In Hospital (epinephrine)
In field (FIRST LINE – EPIPEN)
Corticosteroid agents
Benadryl
Provide intravenous fluids.
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Treatment of Allergies
Sedating effect traditional antihistamine agents
SHORT ACTING:
Diphenhydramine hydrochloride (Benadryl)
Controls moderate to severe allergic reactions
Dimenhydrinate (Dramamine) Relieves motion sickness, nausea, and vomiting
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Treatment of Allergies
The Nonsedating antihistamines
Long Acting (examples): Cetirizine hydrochloride (Zyrtec)
Loratadine (Claritin) Adults and children older than 6 years
Loratadine plus pseudoephedrine (Claritin D)
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Mucous Membrane Lining of the Respiratory Tract
Expectorant agents
Liquefy mucus in the bronchi
Require sufficient fluid intake
Ex. Mucinex
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Administration of Drugs by Inhalation
Drug classes of drugs available by inhalation:
Bronchodilator agents Albuterol, Xopenex – for acute attack and prophylaxis
Combination bronchodilator agent and steroid agent inhaler Advair – for prophylaxis
Corticosteroid agents Azmacort – anti-inflammatory and for prophylaxis
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Drugs That Affect the Heart Heart failure is treated with several classes of drugs:
Angiotensin-converting enzyme (ACE) Inhibiors (Capoten, Vasotec) Ace Inhibitors exact mode of action is debated. (annoying side effect “nonproductive cough”) Ace Inhibitors are the drug of choice (first line) for treating congestive heart failure. Suffix “pril” – e.g. Captopril (Capoten)
Beta blockers (Tenormin) Beta blockers are of greatest benefit to patients with reduced “ejection fraction”. Suffix “olol” – e.g. Atenolol (Tenormin)
Angiotensin II Receptor Blockers Used after MI; greatest benefit to patients who cannot tolerate the ACE inhibitors. Suffix “sartan” – e.g. Telmisartan (Micardis)
Inotropic drugs Inotropic drugs increase contractility of the heart muscle. (antidote = Digibind) -e.g. Digitalis (Digoxin)
Diuretic agents Diuretics promote the formation and excretion of urine. -e.g. Furosomide (Lasix)
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Diuretic Agents Used in combination with other drugs to treat
heart failure Reduces fluid volume
Reducing fluid in the lungs
Reduce s dyspnea
Examples: Furosemide (Lasix) Metolazone (Zaroxolyn) Hydrochlorothiazide (HydroDIURIL)
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Vasoconstricting Agents Epinephrine injection, (Adrenalin)
Prolongs the effectiveness of a local anesthetic:
Epinephrine (Adrenalin) is used in combination with the Novacaine. (e.g. dental anesthetic)
Frequently used in eyes to constrict blood vessels
Use during “codes”, resucitation
Markedly increases blood pressure
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Vasodilating Agents
Cause the blood vessels to relax or increase in diameter
Used to treat peripheral vascular diseases, heart conditions, hypertension
Nitrates
Chief use is to treat angina pectoris
Nitroglycerin (Nitrostat)
Topical nitroglycerin (Transderm-Nitro)
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Coagulant Agents Vitamin K
Fat-soluble vitamin needed for normal blood coagulation
Vitamin K is the antidote drug to warfarin (Coumadin) overdose Colloidal solution of vitamin K is AquaMEPHYTON
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Heparin Prevention and treatment of venous thrombosis
Heparin - Available as sodium heparin injection
Not active orally; must be given parenterally (intravenously or subcutaneously)
Heparin use is recommended when immediate effect is desired
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Coumarin (Coumadin) Anticoagulant Agents Uses:
treatment of thromboembolic disorders (DVT)
Treatment of atrial fribulation
Alters the synthesis of blood coagulation factors
Main advantage: May be taken orally
Main disadvantage: Do not take effect for 2 to 7 days
Coumarin agents are adjusted using PT/INR blood testing
Accepted theraputic PT Ratio is 1.5 to 2.5
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Thrombolytic Therapy for Myocardial Infarction
Uses:
Dissolves clots
Rescue the myocardium
Examples:
Streptokinase (Streptase)
Urokinase (Abbokinase)
Alteplase (Activase, rt-PA, t-PA)
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Anti-platelet Therapy in Cardiovascular Disease
Antiplatelet drugs Interfere with platelet aggregation on the surface of atherosclerotic plaques
Prevent the formation of thrombi and emboli
Drugs
Plavix
Inhibits platelet aggregation
Used for patients allergic to aspirin.
Aspirin
If myocardial infarction is suspected, 325 mg;
otherwise 81 mg daily
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Antilipidemic Drugs Antilipidemic Drugs are used to bring total cholesterol
level to ~ 160 mg/dL. Monitor Liver Functions Tests
Increase in LFTs, may indicate liver toxicity/impairment.
Monitor Serum Creatine Kinase Increase in Serum CK, may indicate skeletal muscle damage
Atorvastatin calcium (Lipitor)
Lovastatin (Mevacor)
Pravastatin (Pravachol)
Rosuvastatin (Crestor)
Simvastatin (Zocor)
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Central Nervous System Stimulant Agents Increase the activity of the brain and spinal
cord. Used to treat:
1. attention-deficit/hyperactivity disorders (ADHD) in children
2. Narcolepsy
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Drugs Used to Treat ADHD Amphetamine Agents stimulate the Central
Nervous System:
Ritalin
Dexedrine
Adderall
Strattera
Monitor growth & development in children
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Central Nervous System Depressants Anesthesia - May be general, systemic, or localized
Pharmacologic CNS depressant
Produces loss of sensation
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Hypnotic and Sedative Agents
Uses include the following:
Daytime sedation–smaller doses Sleep induction–larger doses Pentobarbital (Nembutal) Secobarbital (Seconal)
Benzodiazepines diazepam (Valium) Lorazepm (Ativan) Chlordiazepoxide (Librium) Alprazolam (Xanax)
Nonbenzodiazepine (sleeping pills) Eszopiclone (Lunesta) Zolpidem (Ambien)
Considerations for older adults:
Doses may need to be reduced because of slower metabolism and excretion. Overdose may occur at or below standard doses. Initiate medication with a lower dose and observe the effect, then increase the
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Barbiturate Agents Act by depressing the respiratory rate, blood pressure,
and temperature, as well as the CNS Do not relieve pain Response to barbiturate agents may be:
mild sedation hypnosis general anesthesia depending on the dose and the method of
administration Problems:
Tolerance Addiction
Treatment for barbiturate overdose poisoning Respiratory support Possible dialysis
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Opiate Agents Morphine
Demerol
Vicodin
Percocet
Drug effects
Potent pain reliever
Respiratory center depression
Cough center depression
Decreased peristalsis, nausea, constipation
Patients on opiate pain medication for an extended period of time need to take stool softeners to prevent the incidence of constipation.
Impaired motor coordination
Constricted pupils (pinpoint)
Treat overdose with antidote drug Narcan 37
Antimigraine Agents Triptan agents
Examples:
Sumatriptan succinate (Imitrex)
Causes vasospasm to relieve migraine.
Side effects include: angina, hypertension and Raynoud’s phenomenon.
Use with extreme caution in patients with heart disease
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Parkinson’s Disease May be associated with dopamine depletion in brain
Dopaminergic agents
Used only in adults
Examples:
Levodopa plus carbidopa (Sinemet)
Combination Drug
Levodopa (Larodopa)
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Mild Pain Relief Mild pain
Nonsteroidal antiinflammatory drugs (NSAIDs) or nonopioid analgesic agents Acetaminophen (Tylenol)
Aspirin
Celecoxib (Celebrex)
Ibuprofen (Motrin)
Indomethacin (Indocin)
Ketorolac tromethamine (Toradol)
Naproxen sodium (Naprosyn)
Sulindac (Clinoril)
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Progressive Levels of Pain Relief Moderate pain
Drugs for moderate pain include the following: Hydrocodone bitartrate (Vicodin)
Oxycodone hydrochloride, combined (Percocet)
Tramadol, hydrochloride (Ultram)
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Progressive Levels of Pain Relief Severe Pain
Fentanyl citrate (Duragesic)
Hydromorphone hydrochloride (Dilaudid)
Meperidine hydrochloride (Demerol)
Morphine sulfate (MS Contin)
Oxycodone (Oxycontin)
Nalbuphine (Nubain) – used for patient with a history of opiod addiction.
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Neuropathic Pain
Causes include diabetes, phantom pain after limb amputation
Pain can be progressive; begins in feet and legs, and produces numbness and disability
Drugs Gabapentin (Neurontin)
Pregabalin (Lyrica)
Lidocaine patches 5% (Lidoderm)
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NSAIDS Non-steroidal Anti-inflammatory Drugs
Aspirin, acetylsalicylic acid (Oldest and most common NSAID) Long used as an analgesic (pain reliever) and an anti-inflammatory
agent
Reduces fever
Inhibits the synthesis of prostaglandins
Used to relieve mild to moderate pain
Used to treat headaches
Anti-inflammatory medication in arthritic conditions
Decreases platelet aggregation to reduce risk of clot formation
Relationship established in children between taking aspirin and development of Reye’s syndrome
Do not give Aspirin to children under 18 years old.
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Non-steroidal Antiinflammatory Drugs
Diclofenac (Voltaren)
Diflunisal (Dolobid)
Etodolac (Lodine)
Ibuprofen (Motrin) Used as anti-inflammatory agent
Used to treat menstrual cramps and ovulation pain
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Depression Selective Serotonin Reuptake Inhibitors
Other examples:
Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Fluvoxamine (Luvox)
Sertraline (Zoloft)
Paroxetine (Paxil)
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Tricyclic Antidepressant Agents
Examples: Amitriptyline hydrochloride (Elavil)
Nortriptyline (Pamelor)
Desipramine hydrocholoride (Norpramin)
Desipramine (Norpramin)
Imipramine (Tofranil)
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Depression Monoamine Oxidase Inhibitors
MAOIs inhibit monoamine oxidase in the brain. Last drug choice for depression. Many drug-food interactions
Chianti wine, older cheeses, chicken liver, avocados, pickled herring, figs, alcoholic beverages
Severe increase in blood pressure occurs when these foods combined with MAOIs
Best results obtained when used for true depressive states Parnate Nardil
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Tranquilizing Agents
Benzodiazepine agents
Alprazolam (Xanax)
Chlordiazepoxide hydrochloride (Librium)
Diazepam (Valium)
Lorazepam (Ativan)
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Antipsychotic Agents Nonphenothiazine agents
Examples:
Aripiprazole (Abilify)
Haloperidol (Haldol)
Loxapine (Loxitane)
Olanzapine (Zyprexa)
Pimozide (Orap)
Quetiapine fumarate (Seroquel)
Risperidone (Risperdal)
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Treatment for Helicobacter H. Pylori
Prevpak
Prepackaged combination drug used twice a day for 10 to 14 days
Contains the following:
Amoxicillin (Amoxil) 1 g
Clarithromycin 500 mg
Lansoprazole 30 mg
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Antisecretory Agents Cimetidine (Tagamet)
Serious Side effects can occur with use in the elderly
Avoid using Tagamet in older patients, as they are more sensitive to medications. Increased susceptibility to mental confusion, agitation, psychosis, and hallucinations
Esomeprazole (Nexium) Lansoprazole (Prevacid) Omeprazole (Prilosec)
Pantoprazole (Protonix)
Used to treat erosive gastritis, erosive esophagitis, and gastroesophageal reflux disease
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Antacid Agents Tums (calcium carbonate)
Magnesium oxide (MOM)
Antacid in small doses
Laxative in larger doses
Sucralfate (Carafate) Provides a mechanical barrier to gastric ulcers.
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Digestant Agents
Pancrelipase (Viokase, Pancrease, Ku-Zyme, Creon, Ultrase)
Used in cystic fibrosis because of pancreatic dysfunction
Lactase enzyme (Lactaid)
Digests lactose or milk sugar;
Used in lactose intolerance.
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Emetic Agents Ipecac syrup
Induces vomiting for 30 minutes
Inhibited by milk
Dose should be followed by additional fluids
Should not be used in poisoning with caustic or corrosive substances
Produce vomiting. Never induce vomiting unless instructed to do so. Always call Poison Control first.
Largely replaced by gastric lavage with stomach tube.
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Antiemetic Agents Dimenhydrinate (Dramamine)
Used for vomiting sedates Relieves motion sickness
Ondansetron hydrochloride (Zofran) Administered intravenously or by mouth Used for severe nausea and vomiting Used postoperatively and with chemotherapy
Prochlororperazine maleate (Compazine) Also acts as tranquilizing agent Used postoperatively to control vomiting
Trimethobenzamide hydrochloride (Tigan) Related to antihistamine agents Acts on the vomiting center to decrease nausea
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Cathartic Agents Bulk-increasing laxatives
Examples: Psyllium seed (Metamucil) Methylcellulose (Citrucel)
Fecal softeners Surfactants or detergents Mix with fecal material, emulsifying and softening it for easier
elimination Docusate sodium (Colace)
Irritant cathartic agents Irritate intestinal mucosa and prompt contraction Examples:
Castor oil Senna (Senokot) Biscodyl (Dulcolax)
Saline cathartic agents Act in 1 to 4 hours Examples:
Magnesia magma (milk of magnesia) Magnesium citrate solution (citrate of magnesia)
Commonly used to evacuate bowels before surgery. Electrolytes for oral solution (GoLYTELY)
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Antidiarrheal Agents Diphenoxylate hydrochloride plus atropine sulfate
(Lomotil)
Inhibits gastrointestinal motility; acts similarly to morphine
Atropine is purposely added to Lomotil to decrease chances of overuse of the drug. Atropine causes unpleasement sideffects such as tachycardia, dry mouth.
Loperamide hydrochloride (Imodium)
Slows intestinal motility by acting directly on nerve endings in the intestinal wall.
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Thyroid Preparations Synthetic thyroid preparations (provide greater
accuracy and predictability when treating thyroid dysfunction)
Synthroid
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Antithyroid Agents
Reduce thyroid hormones
Treat hyperthyroidism and Graves’ disease
Should not be taken by pregnant women Can induce goiter and hypothryoidism in the developing
fetus.
Tapazole and PTU are used to suppress the thyroid gland before)
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Cortisone and Hydrocortisone Potent antiinflammatory drugs
Suppress symptoms of arthritis, bursitis, and skin diseases
Used to treat multiple sclerosis
Side effects
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– Muscular weakness
– Acne
– Peptic ulcers
– “Moon face”
– Hirsutism
– Mental disturbances
– Fluid retention
Steroids Cortisone and Hydrocortisone
Synthetic compounds Prednisone (Deltasone)
Hydrocortisone (Solu-Cortef - IV)
Prednisolone (Cotolone)
*Patients that are on long-term steriod therapy are at risk for the unrecognized incidence and advancement of Tuberculosis or Perforated Ulcers.
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Oral Hypoglycemic Agents Used only by type 2 diabetics In order for Oral hypoglycemics to be effective the patient’s
pancreas MUST have the ability to release some residual insulin.
Drugs
Metformin hydrochloride (Glucophage) Glipizide (Glucotrol) Glyburide (Diabeta, Micronase) Glimepiride (Amaryl) Pioglitazone (Actos) Rosiglitazone maleate (Avandia)
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Hormone Replacement Therapy Estrogen replacement therapy (ERT)
Estrogens, conjugated (Premarin)
• Hormone replacement therapy, for women going through menopause, has been associated with Breast Cancer and Cardiovascular complications.
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Oral Contraceptives Side effects (High Risk – Smokers and Obese Patients)
Breast changes Loss of hair Dermatoses Headache Nervousness Thromboembolic disorders Emotional instability Accelerated growth of fibroids Less effective with antibiotic agents
Examples: Levonorgestrel plus ethinyl estradiol (Triphasil) Levonorgestrel plus ethinyl estradiol (Seasonale)
Emergency contraceptives Taken within 72 hours after intercourse Drugs
Levonorgestrel (Plan B)
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Agents to Promote Ovulation
Used as a last resort in an attempt to promote pregnancy in a women previously unable to conceive
Only one agent in United States
Clomiphene citrate (Clomid)
Multiple conceptions is a risk
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Oxytocic Agents Uterine stimulant, like hormone oxytocin
Used during pregnancy, delivery, and postpartum
Drugs Oxytocin injection (Pitocin, Syntocinon)
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Male Hormones
LH causes testosterone production Treatment of “low –T”, hypogonadism in adolescents Testosterone
Development of male reproductive tract Maintains secondary sex characteristics Assists in developing penis, seminal vesicles, prostate gland,
and descent of testes Restores well-being Resists fatigue
Examples Testosterone gel (Angrogel)
Testosterone transdermal system (Androderm)
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Thiazide (Benzothiadiazine) Diuretic Agents Side effects are as follows:
Decreased blood pressure
Tachycardia, jaundice, anemia, alkalosis, hypotension
Used with caution with patients who have the following: Gout
Liver or kidney disorders
Chlorothiazide (Diuril) Used in heart failure, pregnancy, and premenstrual fluid
retention
Hydrochlorothiazide (HydroDIURIL) More potent that chlorothiazide
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Diuretic Agents Furosemide (Lasix)
Loop diuretic
Acts on the collecting tubules of the nephron
Used in congestive heart failure (CHF) associated with liver or kidney disease
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Cancer Treatments Act by interfering in a specific phase of cell
metabolism
In theory, should cause only a minimal interruption in the metabolism of normal cells
SIDE EFFECTS OF CHEMOTHERAPY; Often cause severe bone marrow suppression, requiring
withdrawal of the drug.
Significant decrease in WBCs Nadir – lowest point of WBCs, platelets, & RBC. ~ 10 day post-
chemo
Rx: epoetin alfa (Epogen, Procrit), or filgrastim (Neupogen)
Other side effects: loss of gastrointestinal epithelium, nausea, diarrhea, ulcers of the oral mucosa
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Immunizations Vaccines
Diphtheria and tetanus toxoids, adsorbed (DT, Td) For boosting immunity when pertussis immunization is
unnecessary
Diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) (Tripedia, Infanrix)
Measles, mumps, and rubella virus vaccine, live, (MMR) (M-M-R II) This vaccine is shown to confer immunity as effectively as single
vaccines.
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Agents That Provide Active Immunity Hib Vaccine - Haemophilus b conjugate vaccine
H. influenzae infections in infants and young children.
Hepatitis B vaccine (Recombivax HB)
Flu vaccine – injectable
Flumist vaccine - Influenza virus vaccine live, intranasal Intranasal form compares favorably with other injectable forms
Human papillomavirus vaccine – HPV - (Gardasil)
Intended for females between 11 and 26 years old
Protects against four types of HPV
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Agents That Provide Active Immunity
Tetanus toxoid, tetanus vaccine Often chosen for periodic tetanus boosters after childhood
Varicella virus vaccine, live (Varivax) For prevention of varicella virus (chickenpox)
Development of antibodies does not always occur
Zoster vaccine live (Zostavax) For prevention of herpes zoster in individuals 60 years and older
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Cayenne (Capsicum) Taken orally, cayenne is a digestive aid.
It stimulates the production of gastric juices and helps relieve gas.
Cayenne pepper’s active ingredient, capsaicin, can be applied topically for pain relief.
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Echinacea Extracts made from this root were favorite cold
remedies before antibiotic agents.
May be taken prophylactically to prevent colds or taken early in the infection.
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Garlic Garlic was used in ancient times in poultices as an
effective antibacterial agent.
Some effectiveness is noted in the lowering of cholesterol and triglyceride levels.
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Ginkgo biloba Studies have shown that seeds and leaves of ginkgo
tree do the following:
Relieve symptoms of intermittent claudication
Increase walking performance
Somewhat diminish lower extremity pain
An increase in bleeding time and subdural hematomas is observed with prolonged use.
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St. John’s Wort The medicinal parts of St. John’s wort plant.
It is used effectively to treat mild depression.
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