PharmacologyFinal Part 2…everything not on Part 1

What are adverse reactions to anti-infectives?

Treatment for Active TB Chemotherapy, or taking a drug to treat disease, is

recommended for patients with active TB Anti-TB drugs are classified as primary or secondary

agents to describe the way they are used in treating TB Most primaries are bactericidal and are necessary to

sterilize the TB lesions Secondaries are generally less effective and more toxic

than primary agents Regimen for adults and children that do not have HIV

concurrently is: Isoniazid (INH), rifampin (RIF), & pyrazinamide (PZA) and either

ethambutol (EMB) or streptomycin sulfate (SM) for 8 weeks EMB or SM can be added to the initial regimen if needed INH & RIF daily or two to three times per week for 16 weeks or

up to 6 months Continue for 6 months beyond culture conversion

Cephalosporin & Penicillin & Allergies

Penicillin & Allergies› Allergies can develop at any time› Nurses should take bp & pulse before giving

IM injections to have baseline info› Patient should be asked to wait 30 minutes

after PO or IM before leaving clinic› Anaphylatic shock reactions have occurred

with both oral and parenteral penicillin therapy

Cephalosporin & allergies› Allergic reactions range from mild erythema

to anaphylaxis

Tetracycline Teaching

Zovirax Acyclovir capsule, tablet, suspension Antiviral Indicated for the acute

treatment of herpes zoster (shingles); the initial episodes and management of recurrent episodes of genital herpes; and the treatment of chickenpox

Can cause anaphylaxis, angioedema, fever, headache, pain, ataxia, coma, delirium, dizziness, seizure, diarrhea, N/V, GI distress, anemia, leukopenia, jaundice, pruritus, urticaria, alopecia

Nystatin Antimycotic poly-ene antibiotic Indicated for treatment of candidiasis

In the oral cavity Well tolerated even with prolonged

treatment Can cause: diarrhea, N/V, GI upset,

rash/urticaria, tachycardia, myalgia

What is a superinfection & when would you expect to develop it?

Superinfections are infections that result from antibiotic use

Organisms that are not sensitive to a prescribed antibiotic (i.e. yeast) are able to multiply, overgrow, and get out of control because the antibiotic also killed the organisms that would’ve kept them under control

You would expect to develop them after using broad spectrum antibiotics mostly, particularly after long term use of the broad spectrum antibiotic

Reactions like diarrhea, oral thrush, and vaginal itching are examples

Adverse reactions to antineoplastics

Nausea & Antineoplastics Antiemitics may be prescribed for

nausea Dehydration must be avoided Meals should be made as palatable as

possible If patient is unable to eat, holding ice

chips in the mouth may bring some relief

Methotrexate Can cause severe complications or even death Antineoplastic antimetabolite indicated for use in patients with

malignancy, psoriasis, and rheumatoid arthritis that have not responded to other treatments

NOT for use in pregnant women or patients with impaired renal function

SE: bone marrow suppression, aplastic anemia, GI toxicity, fetal death, bone marrow/liver/lung/kidney toxicity, fibrosis, cirrhosis, diarrhea and ulcerative stomatitis, potentially fatal skin reactions/opportunistic infections, N/V, gingivitis, pericarditis/effusion, hypotension…

Monitor vital signs; monitor for abdominal pain, diarrhea, stomatitis, bone marrow depression, intake/output ratio and weights daily

Apply pressure to venipuncture sites for 10 minutes Monitor for symptoms of pulmonary toxicity which may present as dry,

nonproductive cough Monitor serum levels every 12-24 hours during high-dose therapy

sessions With high dose therapy sessions patient must receive Leucovorin

rescue every 24-48 hours

Why get immunizations? Immunizations are important to protect

patients from communicable, preventable diseases

PPD & Toxoids PPD = purified protein derivative…it is

used in screening procedures to identify people who have been exposed to a specific disease or who may have an active disease such as TB

Toxoids = a weakened, attenuated toxin that can be used to produce immunity because the body cannot distinguish between the toxin and the toxoid…the most common example is the use of the tetanus toxoid to protect patients from Clostridium tetani

Vaccines are…

Artificially Acquired Active Immunity = immunity acquired through the use of live or attenuated antigens in the form of vaccines

Muscle Relaxants Limit the transmission or movement of impulses in the

motor pathways at the level of the spinal cord and brainstem, or they interfere with the mechanism that shortens skeletal muscle fibers

Main action is to reduce muscle tone and involuntary movement without loss of voluntary motor function…other actions include mild sedation, reduction of anxiety and tension, and changes in pain perception

Used to relieve pain in musculoskeletal and neurologic disorders involving peripheral injury and inflammation, often used after trauma

Can be habit forming…long term use is NOT recommended

Not for use in children or rec. for use in patients with a history of alcohol/drug abuse

Antigout Meds

NSAIDs

Gout

A form of arthritis caused when the body makes too much or does not get rid of enough uric acid

High levels of uric acid cause the excess uric acid to form crystals usually in the kidneys and in joint spaces

These crystals have long, sharp, and jagged edges that can tear and bruise the tissues with which they come in contact

Anorectal Meds Include emollients, foams, and gels for

topical anesthesia or healing of the rectal area

Used for symptomatic relief of discomfort from hemorrhoids

May be used on long-term basis or briefly

Dibucaine, hydrocortisone acetate, zinc sulfate monohydrate, and hydrocortisone foam

Elimite/Permethrin Topical scabicidal indicated for the treatment of

infestation with Sarcoptes scabiei Massage into skin from head to soles of feet Scabies rarely infests the scalp of adults,

although the hairline, neck, temple, and forehead may be infested on infants and in geriatrics

Cream should be removed by washing after 8 to 14 hours

One treatment is generally curative Persistent pruritis is common and is not

indicative of treatment failure; living mites after 14 days indicates that retreatment is necessary

Nicotine patches Adjunct therapy in the management of nicotine

withdrawal 70% of nicotine released from the system is

absorbed through the skin Enters breast milk 1-2 hr half life; rapid onset; 2-4 hour peak Can cause: headache, insomnia, pharyngitis,

burning at patch site, erythema, pruritus Monitor for signs of overdose/toxicity…N/V,

diarrhea, increased salivation, abdominal pain, dizziness, auditory or visual disturbances, weakness, hypotension, or irregular pulse

Can be worn for 16-24 hours

Differin gel/Adapalene Indicated for the topical treatment of

acne vulgaris in patients 12 years and older

On face and any other affected areas of the skin once daily in the evening after cleansing gently with non medicated soap

Can cause itching, erythema, and mild pruritus

Proparacaine Opthalmic medication Provides brief local anesthesia to allow

measurement of intraocular pressure, removal of foreign bodies, or other superficial procedures

Repeated use may result in increased risk of CNS and cardiovascular toxicity

Adults and children…1-2 drops of 0.5% solution (single dose)

MucoMyst Acetylcysteine Antidote and mucolytic indicated for management of

potentially hepatotoxic overdosage of acetaminophen and the management of conditions associated with thick viscid mucous secretions

Use cautiously with severe respiratory insufficiency, asthma or history of bronchospasm

SE: drowsiness, vasodilation, rhinorrhea, N/V, stomatitis, rash, pruritus, urticaria

When used as an antidote, assess for anaphylactoid reaction, monitor AST/ALT, and bilirubin levels along with prothrombin every 24 hrs for 96 hrs

Monitor cardiac and renal function (creatinine, BUN), serum glucose, and electrolytes

As an antidote it is most effective when given within 8 hours of ingestion…dilute in DW5

Accutane/Isotretinoin Indicated for the treatment of severe recalcitrant nodular acne Causes birth defects…not for use in pregnant women Only approved for marketing to fertile women through iPledge program run by FDA…

must be dispensed through a pharmacy to patients who have been registered and meet all the requirements of iPledge which is a series of questions/requirements about pregnancy testing and 2 forms of contraception

Related to vitamin A and retinoic acid 15 to 20 week courses of therapy Adverse reactions are similar to those reactions seen in patients taking very high

doses of Vitamin A:› Chelitis› Hypertriglyceridemia› Allergic reactions including: vasculitis, systemic hypersensitivity,› Edema› Fatigue› Lymphadenopathy› Weight loss› Tachycardia› Stroke› Inflammatory bowel disease› Anemia› Thrombocytopenia› Myalgia› Pseudomotor cerebri› Suicidal ideation

Timoptic/Timolol maleate Opthalmic Non-selective beta-adrenergic blocking

agent indicated for the treatment of intraocular pressure in patients with ocular hypertension or open-angle glaucoma

Patients should have a determination of intraocular pressure approximately 4 weeks after first treatment

Most frequent adverse reactions are burning/stinging upon application…others include: › Headache› Bradycardia, arrhythmia, hypotension, hypertension,

syncope, heart block, CVA› N/V, diarrhea, dyspepsia, anorexia› Lupus› Dizziness, paresthesia, somnolence, insomnia, depression› Alopecia, rash› angioedema