Transcript 56611_CH07_Pharmacy

Biomedical
Sciences
Pharmacology
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Foundations of Clinical
Pharmacology
©2010 Jones and Bartlett Publishers
Drug Development Phases
• Pre-FDA
–Manufacturer develops drug
–In vitro testing using animals and human cells
–Studies in animals
–Manufacturer applies to FDA for investigation
new drug (IND) status
• IND
–Clinical testing
–Phase I, II, III lasting from 2-10 years
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Drug Development Phases
• New Drug Application (NDA)
– Submitted after phases I, II, III complete and
found safe
– Committee of experts recommends to FDA
• FDA
– Approves or disapproves drug for use and
assigns to drug category
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Orphan Drug Act - 1983
• Passes to encourage development and
marketing of products used to treat rare
diseases
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Drug Names
Drug name and example
Explanation
Chemical name
Example: ethyl4-(8-choloro5, 6-dihydro-11 H-benzo[5,6]
cycloheptal [1,2-b]-pyridin11-ylidene)-1piperidinecardisplayylate
Exact chemical makeup of drug and placing
of atoms or molecular structure; not
capitalized
Generic name
(nonproprietary)
Example: loratadine
Name given to drug before it becomes
official; may be used in all countries, by all
manufacturers; not capitalized
Official Name
Example: loratadine
Name listed in U.S. Pharmacopedia National
Formulary; may be same as generic name
Trade name (brand name)
Example: Claritin
Name registered by manufacturer and is
followed by trademark symbol; name can
only be used by manufacturer; drug may
have several names depending on number
of manufacturers; first letter capitalized
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Drug Categories
• Prescription
–Also called legend drugs, must be prescribed
by licensed health care provider
–Largest category
• Nonprescription
–Also called OTC; safe if taken as directed
• Controlled substances
–Most carefully monitored with high potential for
abuse
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Pharmaceutic Phase
• Dissolution of drug (tablet or capsule)
disintegrates into small particles and
dissolves into body fluids within the
gastrointestinal tract+
• Entericcoated tablets do not disintegrate until
reaching the alkaline environment of the small
intestine
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Pharmacokinetic Phase
• Activities involving drug within body after
administered
• Absorption - available for use in body
• Distribution - systemic circulation
• Metabolism - liver converts to inactive
compounds
• Excretion - elimination from body through
kidneys, sweat, breast milk, breathing, or feces
• Half-life - time required for body to eliminate
50% of drug
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Pharmacodynamic Phase
• Drugs actions and effects within the body;
primary effect or therapeutic effect and
secondary effects (may or may not be desirable)
• Alteration in cellular environment
–Some drugs change cellular environment
physically or chemically (ie sunscreen alters cell
environment)
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Pharmacodynamic Phase
• Alteration in cellular function
– Most drugs act on altering cellular function
• Drug interacts with receptor that binds to
drug molecule
• Agonist
– Drugs that bind with receptor to produce
therapeutic response
• Antagonists
– Join with receptor and prevent action of an
agonist
– Used on ODs
– Example: Narcan a narcotic antagonist that
blocks the effects of morphine
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Drug Reactions
• Adverse
–Undesirable
• Allergic
–Hypersensitivity; antigen-antibody response
• Drug idiosyncrasy
–Abnormal reaction to drug
• Drug tolerance
–Decreased response to a drug
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Drug Reactions
• Cumulative drug effect
– Drug not metabolized and excreted prior to
next dose
• Toxic reactions
– Drug administered in large doses or blood
concentration levels exceed therapeutic levels
• Pharmacogenetic reactions
– Pharmacogenetic disorder is a genetically
caused abnormal response to a normal dose
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Drug Interactions
• Drug-drug
–Additive drug reaction (1+1=2)
–Synergistic drug reaction (1+1=4)
–Antagonistic drug reaction (1+1=<1)
• Drug-food
–Food may impair or enhance its absorption
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Factors influencing drug Response
• Age
• Weight
• Gender
• Disease
• Route of administration
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Herbal Therapy and Nutritional
Supplements
• Complementary alternative medicine (CAM)
–Therapies used to complement traditional
health care
–CAM
• Massage
• Dietary supplements
• Healing touch
• Herbal therapy
• Alternative therapies
–Used instead of conventional or Western
medical therapies
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Neurologic System
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Nervous system
• Autonomic
– Peripheral nervous system that controls
functions essential for survival
• Central
– Brain and spinal cord
• Parasympathetic
– Autonomic nervous system responsible for
slowing heart rate, digesting food, and
eliminating wastes
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Nervous system
• Peripheral
–Outside brain and spinal cord,
connecting all parts of body
• Somatic
–Peripheral nervous system that controls
sensation and voluntary movements
• Sympathetic
–Autonomic nervous system that
regulates the expenditure of energy and
has key effects in stressful situations
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Neurologic System
• Adrenergic drugs
– Drugs with effects similar to those that occur
in the body when the adrenergic nerves are
stimulated
– Autonomic nervous system that use
norepinephrine as a neurotransmitter
– Used for shock, hypotension, asthma, cardiac
arrest, allergic reactions, heart block,
ventricular arrhythmias, nasal congestion,
prolong anesthetics
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Neurologic System
• Adrenergic blocking drugs
– Drugs that impede certain sympathetic
nervous system functions
– Opposite of adrenergic drugs
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Nervous system
• Alpha blockers
– Block alpha adrenergic receptors resulting in
vasodilation
– phentolamine (Regitine) used to Tx
hypertension
• Beta blockers
– Block beta adrenergic receptors
– Beta adrenergic block drugs decrease the
activity of the sympathetic nervous system in
certain tissue
– Decrease heart rate, dilate blood vessels
• Metoprolol (Lopressor), propranolol (Inderal)
– Eye drops to reduce aqueous humor
• timolol (Timoptic), betaxolol (Betoptic)
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Neurologic System
• Cholinergic drugs
– Mimic activity of the parasympathetic
nervous system
– Glaucoma
• carbachol or pilocarpine (IsoptoCarpine)
eye drops
– Myasthenia gravis
• ambenonium (Mytelase), pyridostigmine
(Mestinon)
– Urinary retention
• bethanechol chloride (Urecholine)
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Neurologic System
• Cholinergic blocking drugs
– Impede certain parasympathetic nervous
system functions
– Pylorospam, peptic ulcer, ureteral and
biliary colic, bradychardia, parkinsonism,
preoperatively to reduce secretions of
upper respiratory tract
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CNS stimulants, Anticonvulsants,
Anti-Parkinsonism
• Ataxia
– Loss of control of voluntary movement
• ADHD
– Short attention span
• Choreiform movement
– Involuntary twitching of limbs and facial
muscles
• Dystonic movement
– Musclular spasms usually affecting tongue,
jaw, eyes
• Epilepsy
– Recurrent seizure disorder
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CNS stimulants, Anticonvulsants,
Anti-Parkinsonism
• Narcolepsy
– Uncontrollable desire to sleep
• Pancytopenia
– Decrease in all cellular components of blood
• Parkinsonism
– Symptoms of Parkinson disease
• Parkinson disease
– Degenerative disorder of CNS; paralysis
agitans
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CNS stimulants
• amphetamine sulfate
– Narcolepsy
• dexmethylphenidate (Focalin)
– ADHD
• methamphetamine (Desoxyn)
– ADHD
• diethylpropion HCl (Tenuate)
– Obesity
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Anticonvulsants
• phenobartital sodium (Luminal sodium)
– Seizures
• phenytoin sodium (Dilantin)
– Seizures
• diazepam (Valium)
– convulsive disorders
• carbamazepine (Tegretol)
– seizures
• valproic acid (Depakote)
– seizures
• magnesium sulfate (Epsom salt)
– evacuation of colon for bowel exams
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Antiparkinsonism
• levodopa (Dopar)
• pramipexole (Mirapex)
• ropinirole HCl (Requip)
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Cholinesterase Inhibitors
• Used to treat dementia associated with
Alzheimer disease
• Increase the level of acetylcholine in the
CNS by inhibiting its breakdown and
slowing the destruction of neurons
– Acetylcholine
• Natural chemical in brain required for memory
and thinking which is lost with Alzheimer
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Cholinesterase Inhibitors
• Alzheimer
– Progressive deterioration of mental and
physical activities
• Dementia
– Decrease in cognitive functioning (memory,
speech)
• Hepatotoxic
– Capable of producing liver damage
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Cholinesterase Inhibitors
• donepezil HCl (Aricept)
• galantamine hydrobromide (Reminyl)
• rivastigmine tartrate (Exelon)
• tacrine HCl (Cognex)
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Antiemetic and Antivertigo
Drugs
• Antiemetic
– Prevents nausea or vomiting
• Antivertigo
– Prevents vertigo
• Emesis
– Vomiting
• Prophylaxis
– Drug or treatment for prevention of a condition
or symptom
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Antiemetic and Antivertigo
Drugs
• chlorpromazine HCl (Thorazine)
– Nausea, vomiting
• diphenhydramine (Benadryl)
– Prevents motion sickness
• promethazine HCl (Phenergan)
– Motion sickness
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Anesthetic drugs
• Preanesthetic drugs
– Demerol
– Atarax
– Valium
– Robinul
– Morphine
• Types of general
anesthesia
– Ethylene
– Halothane
– Nitrous oxide
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Analgesics and Antagonist
•
Analgesic
– Alleviates pain
• Epidural
– Administration into
epidural space
outside dura matter
of the brain and
spinal cord
• Miosis
– Pinpoint pupils
• Opioids
– Narcotic from opium
plant
• Salicylates
– Drugs that have
analgesic, antipyretic
and antiinflammatory effects
• Pain
– Unpleasant sensory
and emotional
experience
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Anesthetic drugs
• Analgesia
– Absence of pain
• Anesthesia
– Loss of feeling or sensation
• Atelectasis
– Reduction of air in the lung
• Brachial plexus block
– Regional anesthesia into brachial plexus
• Epidural block
– Regional anesthesia into space surrounding
the dura of the spinal cord
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Anesthetic drugs
• General anesthesia
– Pain free state for entire body
• Spinal anesthesia
– Regional anesthesia produced by injecting
local into the subarachnoid space of spinal
cord
• Transsacral block
– Regional anesthesia produced by injecting
local into epidural space at the sacroccygeal
notch level
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Non-narcotic analgesics
(Salicylates and Nonsalicylates)
• aspirin (Bayer aspirin)
– acetylsalicylic acid
– Anti-inflammatory
• buffered aspirin (Ascriptin)
– Same as aspirin
• diflunisal (Dolobid)
– Same as aspirin
• magnesium salicylate (Doan’s pills)
– Same as aspirin
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Nonsteroidal anti-inflammatory
• celecoxib (Celebrex)
– Rheumatoid arthritis & osteoarthritis
• ibuprofen (Advil, Motrin)
– Mild to moderate pain, rheumatoid disorders
• ketorolac (Toradol)
– Short term pain, rheumatoid arthritis,
osteoarthritis
• naproxen (Aleve)
– Mild to moderate pain, dysmenorrhea,
rheumatoid arthritis, osteoarthritis
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Narcotic Analgesics
• codeine
– analgesic
• hydromorphone (Dilaudid)
– analgesic
• oxycodone (OxyContin)
– analgesic
• Propoxyphene (Darvon)
– analgesic
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Narcotic Antagonists
• naloxone (Narcan)
– overdose
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Multiple Sclerosis
• Causes demyelination of the nerves of the CNS
causing poor nerve transmission; usually affects
young adults
• Dx
– Muscle weakness, lack of coordination, speech
difficulty, diplopia, loss of bladder function, MRI,
examination of CSF
• Tx
– Interferon beta-1a(avonex), interferon
beta1b(betaseron), glatiramer(copaxone), rebif,
mitoxantrone(novantrone), radiation, steroids,
immune globulin, cytoxic drugs, muscle relaxants,
vitamins, physical therapy
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Psychiatric Drugs
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Psychiatric drugs
• Addiction
– Physical dependence
• Anxiety
– Feeling of apprehension, worry, or
uneasiness that may or may not be based on
reality
• Ataxia
– Loss of control of voluntary movement;
unsteady gait
• Depression
– Intense sadness, helplessness,
worthlessness, impaired functioning
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Psychiatric drugs
• Dysphoric
– Extreme sadness, anxiety
• Soporific
– Another term for hypnotic drug
• Tardive dyskinesia
– Syndrome consisting of potentially
irreversible, involuntary dyskinetic movements
– Occurring especially as a side effect of
prolonged use of antipsychotic drugs
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Psychiatric drugs
• Psychotic drugs
– Antianxiety (tranquilizers) ie: diazepam
(Valium)
– Antidepressants ie: amitriptyline (Elavil),
fluoxetine (Prozac), paroxetine (Paxil),
sertraline (Zoloft), bupropion HCl (Welbutrin)
– Antipsychotic ie: haloperidol (Haldol), lithium
(Eskalith)
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Psychiatric drugs
• Sedatives and hypnotics
– Used to depress CNS, treat insomnia,
respiratory depressants
– Barbiturates
– Misc. sedatives, hypnotics
– Benzodiazepines (antianxiety drugs) ie:
alprazolam (Xanax), chlordiazepoxide
(Librium), diazepam (Valium), lorazepam
(Ativan)
– Nonbenzodiazepines (antianxiety drugs) ie:
busirone (BuSpar), hydroxyzine (Atarax),
zolpidem (Ambien)
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Depression
• Prolonged feeling of extreme sadness
• Dx
– Feelings of rejection, helpless, worthless
– Disinterested in surroundings
– Does not enjoy pleasurable events
– Thoughts of suicide
• Tx
– Psychotherapy, ECT, antidepressants such as
Zoloft, Paxil, Prozace, Wellbutrin
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Schizophrenia
• Excess or distortion of normal functions
• Dx
– Delusions, hallucinations, disorganized
speech, catatonic behavior, confusion, anxiety
• Tx
– risperidone (Risperdal), olanzapine (Zyprexa),
ziprasidone (Geodon), quetiapine (Seroquel),
chlorpromazine (Thorazine), haloperidol
(Haldol), perphenazine (Prolixin)
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Bipolar disorder
• Intense mood swings from hyperactive or
manic to depressive
• Dx
– Family and patient hx
• Tx
– Manic
• lithium carbonate, Depakote, Tegretol
– Depressive
• Antidepressants
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Obsessive-Compulsive Disorder
• Persistent unwanted thoughts (obsession)
and urges to carry out specific actions
(compulsion)
• Dx
– Positron emission tomography (PET)
• Tx
– Hypnosis, exercise, biofeedback
– SSRIs, amitriptyline/nortriptyline
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Alcohol
• Most widely abused substance
• Dx
– Slurred speech, ataxia, incoordination,
euphoria, stupor, respiratory depression
which can lead to aspiration
• Tx
– Maintain airway, thiamin and glucose if
hypoglycemic, Diazepam to control seizures,
activated charcoal if another substance was
ingested
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Drug dependence
Cocaine
Marijuana
Dx: restlessness,
agitation, MI, HTN,
seizure
Dx: palpatations,
euphoria, ↑sensory
awareness, sedation,
anxiety
Tx: Provide reassurance
and support, sedative for
anxiety (Diazepam,
Midazolam), charcoal to
decrease absorption of
marijuana
Tx: diazepam or
lorazepam for seizure,
nitroglycerin for MI,
nitrates for HTN
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Respiratory System
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Pneumonia
• Inflammation of the bronchioles and alveoli
caused by bacteria, virus or other pathogen
• Dx
– Chest X-ray
– Pulmonary function test (spirometry, diffusing
capacity of the lung)
– Blood gases, bronchoscopy, sputum, blood
cultures
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Pneumonia
• Tx
– Penicillin, tetracycline, erythromycin,
sulfonamides, analgesics, O2, ↑ fluids,
bronchodilators, cease smoking, ↑
calories, postural drainage
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COPD
• Group of conditions associated with chronic
obstruction to airflow
– Emphysema
– Acute & Chronic bronchitis
– Bronchiectasis
– Cystic fibrosis
– Pneumoconiosis
• Unable to ventilate, ineffective exchange of
respiratory gases
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Bronchitis
• Dx
– Chest x-ray
– Pulmonary function test (spirometry, diffusing
capacity of the lung)
– Arterial blood gases
– Blood and sputum analysis
• Tx
– Bronchodilator, inhalers, antibiotics, cease
smoking, O2
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Bronchiectasis
• Dx
– Chest x-ray
– Pulmonary function test (spirometry, diffusing
capacity of the lung)
– Bronchoscopy
– Sputum analysis
• Tx
– Bronchodilator, inhalers, antibiotics, cease
smoking, postural drainage, surgery
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Emphysema
• Dx
– Hx of smoking
– Chest x-ray
– Tachycardia, hypertension, polycythemia
– Barrel chest
– Blood gases
• Tx
– O2, cease smoking, ↑ protein diet, beta2adrenergic sympathomimetics (Albuterol),
terbutaline sulfate (Brethine), metaproterenol
sulfate (Alupent), theophylline, expectorants,
antibiotics
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Cystic fibrosis
• Hereditary; large quantities of viscous material
secreted
• Affects sweat glands, bronchi, pancreas and
mucus secreting glands of small intestines
• Dx
– ↑ sodium and chloride in sweat
– ↓pancreatic enzymes
– Chronic pulmonary infections (staph)
• Tx
– Postural drainage, chest clapping, antibiotics,
bronchodilator, ↑ caloric & sodium diet with
pancreatic enzyme supplementation
expectorants, O2
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Pneumoconiosis
• Respiratory diseases caused by exposure
to organic and inorganic dust
– Silicosis, black lung disease, brown lung
disease, asbetosis
• Dx
– Rales and restriction of lung inflation, x-rays,
pulmonary function test, arterial blood gas
• Tx
– O2, Bronchodilator, inhalers, physical tx
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Asthma
• Episodic, acute airway obstruction that
results from stimuli. Allergic reaction.
• Dx
– Wheezing caused by bronchospasm,
dyspnea, pulmonary function test
(spirometry), CBC, differential leukocyte
count, x-ray
• Tx
– Cromolyn sodium, albuterol, theophylinne,
aerosol corticosteroids, epinephrine,
inhalation tx
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Cardiovascular System
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Hypertensive Heart Disease
• Most prevalent cardiovascular disorder in
US
• Result of chronic elevated pressure
throughout vascular system
• Dx
– Atherosclerosis
– Arteriosclerosis
– Renal disease
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Essential Hypertension
• Or primary hypertension, abnormally high
blood pressure in the arterial system
• Dx
– Few symptoms until permanent damage
occurs
– Elevated BP of greater than 140/90 with 120
being borderline hypertension
• Tx
– Diuretics, beta-adrenergic blockers
(Lopressor), vasodilators, calcium channel
blockers, ACE inhibitors (Lisinopril), ↓ sodium,
exercise, reduce stress
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Malignant Hypertension
• Severe hypertension; blurred vision,
headache, dyspnea
• Dx
– BP 200/120
• Tx
– IV vasodilators
• diazoxide (Hyperstat)
• sodium nitroprusside (Nipride)
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Renal Disease
Disease
Diagnostic Methodologies
Treatment
Glomerulonephritis
Urinalysis (blood, WBC), ↑BUN, ↑ESR, ↑
creatinine, enlarged kidney on KUB
radio& ultrasound
Diuretics, ↓ Na, dialysis
Renal failure
↑BUN, creatinine & K, ultrasound,
intravenous pyelogram, kidney scan
↓ Na & K, antihypertensives,
diuretics, antiinfective agents
Pyelonephritis
↑WBC, RBC with bacteria, IVP, utrasound
fluroquinolones (Cipro, Levaquin)
Hydronephrosis
Cystoscopy, pyelogram
Antibiotics, surgery
Renal calculi
KUB radio, IV urogram, ultrasound, CT
Analgesics, lithotripsy, surgery,
↑H2O
Cystitis and urethritis
Urinalysis (blood), cystoscopy
antibiotics (amoxicillin, Bactrim,
Septra, Cipro. Levaquin)
Diabetic nephropathy
Urinalysis (protein, pus) ↑BUN, urinary
microalbumin (albumin)
Control diabetes, dialysis, kidney
transplant
Polycystic kidney disease
Urinalysis (protein, blood, pus), enlarged
kidney on radio & IVP
Dialysis, kidney transplant
Stress Incontinence
Abnormal bladder position on endoscopy
and voiding cystourethrogram (VCUG)
Kegel exercise, estrogen
replacement, surgery
Renal cell carcinoma
CT scan, ultrasound, IVP
Nephrectromy, immunotherapy
with interferon-alfa or interleukin-2
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Heart Failure
• Coronary Artery disease
– Atherosclerosis: caused by plaque in lumen
(opening) or coronary arteries
– Arteriosclerosis: hardening of arteries
associated with the elder and diabetics
• Dx
– Treadmill, ECG shows arrhythmias and
ischemia, cardiac cath & angiogram detect
↓O2
• Tx
– Vasodilators, angioplasty, hypolipidemic
drugs, beta-blockers, anticoagulants, CAB
©2010 Jones and Bartlett Publishers
Congestive Heart Failure
• Acute or chronic inability of heart to pump
enough blood throughout the body to meet
demands of homeostasis
• Dx
– ECG, cardiac catheterization
• Tx
– Digitalis, beta-blockers, ACE inhibitors,
diuretics, vasodilators
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Angina Pectoris
• Chest pain on exertion
• Dx
– Treadmill, ECG shows ischemia, cardiac
catheterization & angiogram detect ↓O2
• Tx
– Nitroglycerin
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Cardiomyopathy
• Noninflammatory disease of cardiac muscle
causing enlargement
• Dx
– Xray reveals cardiomegaly, ECG reveals rate
and rhythm abnormalities, cardiac
catheterization, biopsy
• Tx
– Antiarrhythmic agents, digitalis, anticoagulant,
beta-blockers (Inderal) ↓ heart contractility,
calcium blockers ↓ blood pressure and relax
heart muscle, ACE inhibitors to relax blood
vessels
©2010 Jones and Bartlett Publishers
Myocardial Infarction
• Death of myocardial tissue from ishemia
• Dx
– ECG show ishemia, xray, ↑enzymes include
creatine phosphokinase (CPK), lactic
dehydrogenanse (LDH) and asparate
aminotransferase (AST)
• Tx
– aspirin, O2, vasodilation with nitroglycerin, IV
drip lidocaine, tissue plasminogen activator
(TPA), streptokinase or alterplase (Activase),
thrombolytic drugs, CAB
– Heparin, dalteparin (Fragmin), enoxaparin
(Lovenox), tinzaparin (Innohep)
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CVA
• Brain is damaged by sudden disruption of
blood flow to part to the brain
• Dx
– MRI, CT, cerebral angiography, EEG
• Tx
– anticoagulants (warfarin-sodium (Coumadin),
thrombolytic agents, anti-platelet medications
(aspirin), surgery
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Gastrointestinal and
Urinary Systems
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Gastrointestinal and Urinary Systems
• Hyperkalemia
– High blood level of K (potassium)
• Hypokalemia
– Low blood level of K
• Orthostatic hypotension
– Dizziness and light headedness after standing
in one place for a long time
• Postural hypotension
– Dizziness and light headedness when rising
suddenly from a sitting or lying position
©2010 Jones and Bartlett Publishers
Crohn Disease
• Chronic inflammatory disease of the
alimentary tract
• Dx
– Colonoscopy, barium enema; anemia,
leukocytois and hypoalbuminemia determined
by blood test
– Electrolyte abnormalities due to diarrhea
• Tx
– Incurable but managed with anticholinergics,
narcotics to relieve cramping and diarrhea,
sulfasalazine for infection, corticosteroids and
immunosuppresive drugs, surgery
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Ulcerative colitis
• Chronic inflammatory bowel disease affecting
mucosa and submucosa of the rectum and
colon
• Dx
– Colonoscopy, barium enema, stool cultures
examine for blood & R/O bacterial infection,
biopsy, electrolyte abnormalities noted in
diarrhea
• Tx
– anticholinergic, antidiarrheal agents,
sulfasalazine, corticosteroids, surgical
removal of diseased colon
©2010 Jones and Bartlett Publishers
Diarrhea
• Acute inflammation of the stomach and
intestine linings; rapid passage of stool
through the intestinal tract
• Dx
– Electrolyte studies, stool cultures, abnormal
blood count, endoscopy
• Tx
– Treat cause not symptoms, antidiarrheal
agents, oral and IV rehydration, antibiotics,
antimetics, antacids
©2010 Jones and Bartlett Publishers
Electrolyte Imbalance
• Common adverse reaction to diuretics;
H2O and K (potassium) most common
• Dx
– ↓ K on blood test
• Tx
– Hydration
– K supplements
– Foods high in K
– Changing diuretic to K-sparring diuretic
©2010 Jones and Bartlett Publishers
UTI
• Caused by pathogenic microorganisms
• Dx
– Urinalysis
• Tx
– Anti-infectives
• cinoxacin (Cinobac), fosfomycin (Monurol),
methenamine mandelate (Mandelamine),
nalidixic acid( NegGram), nitroturantoin
(Furadantin)
– ampicillin, cephalosporins, sulfonamides,
Norfloxacin
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Hematuria
• Blood in urine
• Sign of renal and urologic disease or disorder
• Determined through urinalysis
• Hematuria symptom for
– Thrombocytopenia purpura (inability to normally
clot blood)
– Glomerulonephritis (inflammation and swelling of
the glomeruli)
©2010 Jones and Bartlett Publishers
Neutropenia
• Neutrophil disease; neutrophilic leukopenia
• Associated with
– Leukocytosis (↑ in WBC)
– Leukocytopenia (↓ in WBC)
• Dx
– Agglutination (clumping of cells), fluorescent
immunoassay (antigen and antibody
detection)
• Tx
– Injections of Filgrastim and Neupogen
©2010 Jones and Bartlett Publishers
Endocrine System
©2010 Jones and Bartlett Publishers
Diabetes Mellitus
• Chronic disorder of carbohydrate, fat, and protein
metabolism caused by inadequate production of
insulin by the pancreas or faulty utilization of insulin
by cells. Type 1 (insulin dependent) and Type 2
(non-insulin dependent)
• Dx
– Fasting blood plasma glucose
– Urinalysis reveals glucose and acetone
• Tx
– Diet, exercise, blood and urine testing
– Insulin
• Rapid, Intermediate and Long acting (Humulin,
Novolin)
– Open-loop infusion pump
– Injection ports
– Insulin infuser pens
©2010 Jones and Bartlett Publishers
Diabetes Mellitus
– Glucocorticoid (regulate glucose and
metabolize fat, protein and carbohydrates)
– Antidiabetic drugs (Type 2)
• sulfonyluresas (Glimepiride, glyburide)
• biguanides (Metformin)
• alpha-glucosidase inhibitors (Acarbose,
Miglitol)
• meglitinides (Nateglinide, Repaglinide)
• thiazolidinediones (Pioglitazone,
Rosiglitazone)
©2010 Jones and Bartlett Publishers
Diabetes Insipidus
• Failure of pituitary to secrete vasopressin or
from surgical removal of pituitary.
Disturbance of H2O metabolism resulting in
extreme thirst and excessive urine secretion
• Dx
– Urinalysis reveals almost colorless urine with
low specific gravity <1.005
©2010 Jones and Bartlett Publishers
Diabetes Insipidus
• Tx
– Vasopressin injections, nasal spray with
lypressin (Diapid) or desmopressin acetate
(DDAVP), thiazide diuretics block ability of
kidneys to excrete H2O by inhibiting excretion
of K, Ch and H2O
©2010 Jones and Bartlett Publishers
Goiter
• Enlargement of thyroid gland
• Dx
– Blood studies indicate ↑ thyrotropin levels and
↓ levels of T3 and T4
• Tx
– Saturated solution of potassium iodide
– Iodized salt added to diet
©2010 Jones and Bartlett Publishers
Cretinism
• Hypothyroidism developing in early
childhood
• Dx
– Blood level indicates an absence or
abnormally ↓ amount of T4
– Thyroid scan ↓ iodine uptake
• Tx
– Thyroid hormone replacement
©2010 Jones and Bartlett Publishers
Hyperthyroidism
• Grave’s disease – hypertrophy of thyroid
gland resulting in a goiter
• Dx
– ↑ Serum T3 (Triiodothyronine) and T4
(Thyroxine)
– Thyroid scan indicate ↑ uptake of radioiodine
– Blood test reveal ↑ levels of antithyroid
immunoglobulins
©2010 Jones and Bartlett Publishers
Hyperthyroidism
• Tx
– antithyroid drugs propylthiouracil,
methimazole (Tapazole) to block synthesis of
thyroid hormone
– beta-blockers propranolol hydrochroide
(Inderal) and atenolol (Tenormin) to treat
tachycardia and HTN
– Radioactive iodine therapy
– Surgery (thyroidectomy)
©2010 Jones and Bartlett Publishers
Hypogonadism
• Most common pituitary deficiency
among adults
• Dx
– Women: amenorrhea, atropy of breast &
uterus, cornification of vaginal orifice
– Men: testicular atrophy, ↓ libido, potency,
beard growth, muscle tone, eunuchoid
apperance, ↓ 2o sex characteristics
• Tx
– Androgens
• Halotestin, Android, Methitest, Testred,
Virilon, Deop-tetestosterone
©2010 Jones and Bartlett Publishers
Reproductive System
©2010 Jones and Bartlett Publishers
BPH
• Benign Prostatic Hyperplasia is nonmalignant
noninflammatory hypertrophy of prostate
gland
• Dx
– Urinalysis, urine culture, IVP, cystoscopy
• Tx
– alpha-adrenergic blockers: tamsulosin
hydrochloride (Flomax), doxazosin mesylate
(Cardura), terazosin hydrochloride (Hytrine)
– finasteride (Proscar) to shrink prostate
– Surgery TURP
©2010 Jones and Bartlett Publishers
Amenorrhea
• Absence of menstrual periods
• Dx
– Blood and urine to R/O abnormal hormones
and pregancy
– Radiographic studies, laparoscopy, biopsy for
tumors
• Tx
– Progestins
• Hylutin, Amen, Cycrin, Depo-Provera,
Aygestin, Crinone, Prometrium
©2010 Jones and Bartlett Publishers
Contraceptives
• Monophasic Oral
– Lo/Orval, Necon 1/150, Demulen, Ogestrel,
Ovral, Ovcon-35, Loestrine, Ortho-Novum
1/150
• Biphasic Oral contraceptives
– Necon 10/11, Ortho-Novum 10/11
• Triphasic oral
– Tri-Norinyl, Ortho-Novum 7/7/7, Necon 7/7/7,
Ortho Tri-Cyclen, Ortho Tri-Cyclen Lo
©2010 Jones and Bartlett Publishers
Contraceptives
• Progestin Only
– Camila, Errin, Nor-QD, Nora-BE, Ovrette,
Ortho Micronor
• Implants (Progestins)
– Norplant system, Progestasert
©2010 Jones and Bartlett Publishers
Sexually Transmitted Diseases
Most frequently reported. C. trachomatis on swab of body
fluids
Antibiotic tx:
Azithromycin, erythromycin
Common STD of genitourinary tract. N. Gonorrhoeae on
culture of body fluids
Ciprofloxacin, ceftriaxone,
doxycycline
Trichomoniasis
Trichomonas vaginalis found on wet prep of vaginal
secretions of discharge and from male urethra. Protozoal
infection of lower genitourinary tract.
Antiinfective: metronidazole
(Flagyl)
Genital herpes
HSV-2 virus on Enzyme immunoassay and Indirect
Fluorescent Antibody (IFA). Incurable ulcerations of skin
in genital area.
No cure. Acyclovir (Zovirax),
famciclovir (Famvir),
valacyclovir (Valtrex)
Genital warts
Condyloma acuminatum are biopsied to r/o ca. Genital
infection that causes cauliflower like growths
Surgical resection. Chemical
resection: keratolytic agent
(Podofilox)
Syphilis
Treponema pallidum on smear from lesion or chancre
Penicillin G., doxycycline,
tretracycline
Chancroid
Haemophilus ducreyi on gram stain smear of lesion.
Causes necrotizing ulceration and lymphadenopathy
Antibody tx: azithromycin,
clarithromycin, ceftriaxone
Dyspareunia
Painful or difficult sexual intercourse. (endometriosis,
psych, STD, bowed erection, tight foreskin, prostatitis)
Lubricants, vaginal stretching,
surgery, psych counseling
Hepatitis B
HBV. Identify antigens or antibody substances. Except
Hepatitis B immune globin
Hep B, antigen detected by radioimmunoassay and
(HBIG)
ELISA.
Interferon alpha
1. HBsAg (anti-HBs)
2. HBcAG (anti-HBc),
May later
liver ca and
©2010 Jones
anddevelop
Bartlett Publishers
3. HBeAg (anti-HBe)
cirrhosis
Chlamydia
Gonorrhea
Immune System
©2010 Jones and Bartlett Publishers
Antibacterial Drugs
• Sulfonamides
– First antibiotics developed to treat infections
– Antibacterial agents and bacteriostatic
• sulfadiazine
– UTI, acute otitis media, meningitis, rheumatic
fever
• trimethoprim (Bactrim)
– UTI, acute otitis media, diarrhea caused by E.
coli
©2010 Jones and Bartlett Publishers
Antibacterial Drugs
• Mafenide (Sulfamylon)
– Second and third degree burns
• silver sulfadiazine (Silvadene)
– Second and third degree burns
©2010 Jones and Bartlett Publishers
Antibacterial Drugs
• Pencillins
– Four groups
• Natural penicillins: penicillin G
• Penicillinase resistant penicillin: cloxacillin,
nafcillin
• Aminopenicillins: ampicillin, amoxicillin
• Extended spectrum penicillins: mezlocillin,
ticarcillin
©2010 Jones and Bartlett Publishers
Antibacterial Drugs
• penicillin G (Pfizerpen)
– Infections caused by susceptible organisms,
syphillis, gonorrhea
• oxacillin sodium (Bactocill)
– Same as penicillin G
• ampicillin (Omipen)
– Second and third degree burns
©2010 Jones and Bartlett Publishers
Antibacterial Drugs
• Cephalosporins
– Structurally and chemically related to penicillin
– Effective in treatment of most all strains of
bacteria affected by penicillin as well as some
strains of bacteria resistant to penicillin
• cephalexin (Keflex)
– Infections due to susceptible microorganisms
©2010 Jones and Bartlett Publishers
Antibacterial Drugs
• cefaclor (Ceclor)
– Infections due to susceptible microorganisms
• loracarbef (Lorabid)
– Infections due to susceptible microorganisms
©2010 Jones and Bartlett Publishers
Antibacterial Drugs
• Tetracyclines
– Anti-infectives
– Inhibit bacterial protein synthesis
– demeclocycline (Declomycin)
• Infections due to susceptible microorganisms
• Macrolides
– Treat wide range of gram + and –
microorganisms
– erythromycin
• Infections due to susceptible microorganisms
©2010 Jones and Bartlett Publishers
Antibacterial Drugs
• Lincosamides
– Serious infections in which penicillin an
erythormycin is ineffective
– clindamycin (Cleocin)
• Infections due to susceptible microorganisms
©2010 Jones and Bartlett Publishers
Antibacterial Drugs
• Fluroquinolones
– Powerful treatment for resistant
microorganisms
– ciprofloxacin (Cipro)
• Infections due to susceptible
microorganisms
©2010 Jones and Bartlett Publishers
Antibacterial Drugs
• Aminoglycosides
– Powerful treatment for resistant
microorganisms
– netilmicin (Netromycin)
• Serious infections due to susceptible
microorganisms
• Antitubercular
– Treat TB
– ethambutol (Myambutol)
• TB
©2010 Jones and Bartlett Publishers
Antibacterial Drugs
• Leprostatic
– Treat leprosy
– clofazimine (Lamprene)
• Leprosy
• Misc. anti-infectives
– chloramphenicol (Chloromycetin)
• Susceptible infections which less potentially
dangerous drugs are not effective or
contraindicated
– metronidazole (Flagyl)
• Infections caused by susceptible anaerobic
microorganisms, amebiasis, trichomonas
©2010 Jones and Bartlett Publishers
Anti-infective Drugs
• Amebiasis
– Invasion of ameba Entamoeba histolytica
• Cinchonism
– Associated with quinine, including dizziness,
headache, GI disturbances, visual
disturbance
©2010 Jones and Bartlett Publishers
Anti-infective Drugs
• Fungicidal
– Able to destroy fungi
• Fungistatic
– Retard fungi
• Helminthiasis
– Invasion of helminths (worms
©2010 Jones and Bartlett Publishers
Anti-infective Drugs
• Mycotic infection
– Superficial or deep infection caused by fungi
that may be yeast or mold like
• Onychomycosis
– Nail fungus
• Parasite
– Organism that lives on a host without
contributing to the survival or well being of the
host
• Tinea corporis
– ringworm
©2010 Jones and Bartlett Publishers
Anti-infective Drugs
• Tinea cruris
– Jock itch
• Tinea pedis
– Athlete’s foot
©2010 Jones and Bartlett Publishers
Anti-infective Drugs – Antiviral
• abacavir sulfate (Zagen)
– HIV
• acyclovir (Zocirax)
– Herpes simplex and zoster
• docosanol (Abreva)
– HSV 1&2
• zidovudine (AZT) (Retrovir)
– HIV
©2010 Jones and Bartlett Publishers
Anti-infective Drugs – Antifungal
• amphotericin (Amphocinn)
– Fungal infection
• fluconazole (Diflucan)
– Oropharyngeal, vaginal candidiasis,
cyptococcal meningitis
©2010 Jones and Bartlett Publishers
Anti-infective Drugs – Anthelmintic
• thiabendazole (Mintezol)
– Treatment of threadworm
©2010 Jones and Bartlett Publishers
Anti-infective Drugs – Antimalarial
• quinine sulfate
– Malaria
©2010 Jones and Bartlett Publishers
Anti-infective Drugs – Amebicides
• metronidazolee (Flagyl)
– Intestinal amebiasis
©2010 Jones and Bartlett Publishers
Immunologic Agents
•
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•
•
Measles (Attenuvax)
Rubella (MeruvaxII)
Mumps (Mumpsvax)
Rubella and mumps (Biavax II)
Measles (rubeoloa) and rubella (M-R-Vax
II)
• Poliovirus (live) (Orimune)
• Poliovirus (inactivated) (IPOL)
©2010 Jones and Bartlett Publishers
Immunologic Agents
•
•
•
•
•
•
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Influenza (Flushield, Fluvirin, Fluzone)
Hepatitis B (Engerix-B)
Hepatitis A (Havrix, Vaqta)
Hepatitis A and B (Twinriz)
Varicella (Varivax)
Tetanus toxoid
Diphtheria
©2010 Jones and Bartlett Publishers
Anti-neoplastic Drugs
©2010 Jones and Bartlett Publishers
Antineoplastic Drugs
• busulfan (Busulfex, Myleran)
– Chronic myelogenous leukemia
• chlorambucil (Leukeran)
– Chronic lymphocytic leukemia, malignant
lymphomas, Hodgkin’s
©2010 Jones and Bartlett Publishers
Antineoplastic Drugs
• mechlorethamine (Mustargen)
– Hodgkin’s, lymphsarcoma, brochogenic ca,
leukemia, mycosis fungoides
• medroxyprogesterone (Depo-Provera)
– Endometrial or renal ca
• Megestrol acetate (Megace)
– Breast or endometrial ca
©2010 Jones and Bartlett Publishers
Antineoplastic Drugs
• diethylstilbestrol diphosphate (Stilphostrol)
– Inoperable prostatic ca
• leuprolide acetate (Lupron)
– Advanced prostatic ca, endometriosis, central
precocious puberty, uterine leiomyomata
• topotecan HCl (Hycamitin)
– Ovarian ca, small cell lung ca
©2010 Jones and Bartlett Publishers
Antineoplastic Drugs
• thiotepa (Thioplex)
– Ca of breast, ovary, bladder, Hodgkin’s,
lymphosarcomas, intracavity effusions caused
by localized mets
• tetolactone (Teslac)
– Palliative tx of advance disseminated mets
breast ca in postmenopausal women and
premenopausal women whose ovarian
function has terminated
©2010 Jones and Bartlett Publishers
Colorectal Cancer
• Cancer that arises in part of the colon or
rectum. 3rd most common cancer site.
• Dx
– Fecal occult blood
– Barium enema
– Sigmoidoscopy
– Colonoscopy with CT scan, endoscopic
ultrasound
©2010 Jones and Bartlett Publishers
Colorectal Cancer
• Tx
– Surgical resection
– 5-fluorouracil (Adrucil)
– Leucovorin
– irinotecan HCl (Camptosar)
©2010 Jones and Bartlett Publishers
Breast Cancer
• Arises from terminal ductal lobular unit
(TDLU), functional unit of breast tissue
which is very hormonally responsive
• Dx
– Abnormal mammogram, physical exam,
ultrasound, MRI
– Advanced Breat Cancer
• Xray, CT scan bone, tumor estrogen
receptor and progesterone receptor status
©2010 Jones and Bartlett Publishers
• Tx
– Lumpectomy, mastectomy, radiation,
hormone
– Trastuzumab(Herceptin),
Methotrexate(Rheumatrex), 5-fluorouracil
(Adrucil), epirubicin(Ellence),
Capecitabine(Xeloda), tamoxifen
citrate(Nolvadex), anastrazole(Arimidex),
exemestane(Aromasin), letrozole(Femara)
©2010 Jones and Bartlett Publishers
Lymphoma
• Lymph system malignant neoplasms
– Hodgkin lymphoma (or disease) and nonHodgkin
©2010 Jones and Bartlett Publishers
Hodgkin Lymphoma
• Cancer of lymphatic system
• Dx
– Lymph node biopsy shows presence of ReedSternberg cells
– Blood studies indicate mild mormochromic,
normocytic anemia, neutrophilic leukocytosis,
lymphopenia, eosinophilia
– ↑ ESR and serum alkaline phosphatase level
– Bone marrow biopsy, CT scans of chest,
abdomen and pelvis, ultrasound shows
spleen involvement
©2010 Jones and Bartlett Publishers
Hodgkin Lymphoma
• Tx
– Radiation, chemoradiotherapy
– Chemotherapy ABVD (doxorubicin,
bleomycin, vinblastine, dacarbazine)
– Bone marrow transplant
©2010 Jones and Bartlett Publishers
Non-Hodgkin Lymphoma
• Describes a number of heterogeneous
neoplasms of the lymphoid cells ranging from
slow to fast growth
• Dx
– Immunologic, cytogenetic and molecular
studies
– Biopsy of lymph node, CBC, peripheral blood
smear, renal and liver function studies
• Tx
– Radiation therapy
– CHOP chemotherapy (cyclophosphamide,
doxorubicin, vincristine, prednisone) that may
be administred with rituximab
©2010 Jones and Bartlett Publishers
Lung Cancer
• Most common cause of cancer death
worldwide for men and women usually
caused by carcinogenic irritation to bronchial
epithelium leading to increased rates of cell
division
• Dx (SCLC & NSCLC)
– Chest x-ray, sputum cytology + for malignant
cells
– Bronchoscopy with biopsy
– Mediastinoscopy determine lymph node
involvement in mediastinum
– CT scan of chest, abdomen & head
– Bone scan
©2010 Jones and Bartlett Publishers
Lung Cancer
• Tx
– NSCLC
• Surgical resection, radiation,
chemotherapy, palliative tx
– SCLC (metastasizes early)
• Systemic chemotherapy with cisplatin and
etoposide or irinotecan
• chemoradiotherapy
©2010 Jones and Bartlett Publishers
Musculoskeletal
©2010 Jones and Bartlett Publishers
Musculoskeletal Pain
• carisoprodol (Soma)
– Musculoskeletal pain
• cyclobenzaprine HCl (Flexiril)
– Musculoskeletal pain
• diazepam (Valium)
– Muscle spasm, CP, epilepsy, anxiety
• methocarbamol (Robaxin)
– Discomfort due to musculoskeletal disorders
• orphenadrine citrate (Banflex, Flexoject)
– Discomfort due to musculoskeletal disorders
©2010 Jones and Bartlett Publishers
Osteoarthritis
• Degenerative Joint Disease
– Breakdown and loss of cartilage of one or
more joints
• Dx
– CT scans, MRI, radiographic films
• Tx
– Analgesics, muscle relaxants(Soma, Flexeril,
Robaxin), NSAIDs (Celebrex, Voltaren,
Cataflam, Lodine, Nalfon, Ansaid, Toradol,
Mobic, Relafen, Anaprox, Daypro, Feldene,
Vioxx, Clinoril, Totectin, Bextra), glucosamine,
chondroitin, surgery
©2010 Jones and Bartlett Publishers
Rheumatoid Arthritis
• Chronic inflammatory systemic disease that
affects joints
• Dx
– CBC, synovial fluid analysis, serum protein
electrophoresis, ESR (Erythrocyte
Sedimentation Rate), antinuclear antibody tier
©2010 Jones and Bartlett Publishers
Rheumatoid Arthritis
• Tx
– Gold compounds (gold sodium
thiomalate(Aurolate), aurothioglucose(Solganal),
auranofin(Ridaura))
– DMARDs (penicillamine, immunosuppressive
agents
– NSAIDs (Celebrex, Voltaren, Cataflam, Lodine,
Nalfon, Ansaid, Toradol, Relafen, Anaprox,
Daypro, Feldene, Clinoril, Totectin, Bextra)
– Enbrel, Plaquenil Sulfate, Arava, Rheumatrex
Dose Pak, Cuprimine, Depen, Azulfidine
©2010 Jones and Bartlett Publishers
Gout
• Chronic disorder of uric acid metabolism that
manifests as an acute, episodic form of
arthritis; chronic deposits of uric acid form
hard nodules in tissue
• Dx
– Synovial fluid analysis show urate crystals
– Urinalysis and serum uric acid show
hyperuricemia
– Radiographic films show joint damage
©2010 Jones and Bartlett Publishers
Gout
• Tx
– Antihyperuricemics (probenecid(Benemid),
allopurinol (Zyloprim))
– Corticosteroids (Prednisolone(Delta-Cortef),
prednisone(Deltasone, Orasone
©2010 Jones and Bartlett Publishers
Skin Disorders
©2010 Jones and Bartlett Publishers
Skin Disorders (antibiotics)
• bacitracin (Baciguent)
– Acne vulgaris
• benzoyl peroxide (Acne 5, Benzac, Loroxide
Neutrogena)
– Acne vulgaris and oily skin
• clindamycin (Cleocin T)
– Acne vulgaris
©2010 Jones and Bartlett Publishers
Skin Disorders (antifungal)
• oxiconazole (Oxistat)
– Tinea pedis
• terbinafine HCl (Lamisil)
– Tinea pedis
©2010 Jones and Bartlett Publishers
Skin Disorders (antiviral)
• acyclovir (Zovirax)
– Herpes genitalis, herpes simplex, virus
infections
©2010 Jones and Bartlett Publishers
Skin Disorders
(antiseptic & germicides)
• triclosan (Clearasil daily face wash)
– Skin cleanser
©2010 Jones and Bartlett Publishers
Skin Disorders
(topical corticosteriods)
• alclometasone dipropionate (Aclovate)
– Allergic / immunologic skin problems
• hydrocotisone (Bactine)
– Allergic / immunologic skin problems
©2010 Jones and Bartlett Publishers
Skin Disorders
(local anesthetics)
• benzocaine (Lanacane)
– Anesthesia in local skin disorders
©2010 Jones and Bartlett Publishers
Otic & Ophthalmic Conditions
©2010 Jones and Bartlett Publishers
Ophthalmic Preparations
• Alpha-adrenergic blocking drugs
– Reverses mydriasis
• Beta-adrenergic blocking drugs
– Elevated IOP
• Miotics
– Glaucoma
• Mydriasis
– Dilation of pupil
• Miotics, Cholinesterase Inhibitors
– glaucoma
©2010 Jones and Bartlett Publishers
Ophthalmic Preparations
• Carbonic Anhydrase Inhibitors
– Elevated IOP
• Prostaglandin Agonist
– Elevated IOP
• sulfonamides
– Conjunctivitis, corneal ulcer, eye infections
• Vasoconstrictors / Mydriatics
– Eye redness
©2010 Jones and Bartlett Publishers
Fluids and Electrolytes
• Electrolyte
– Electrically changed particle (ion) that is
essential for normal cell function and is
involved in various metabolic activities
• Extravasation
– Escape of fluid from a vessel into surrounding
tissue
• Fluid overload
– Fluid administered at a rate greater than body
can eliminate
• Half-normal saline
– Solution containing .45% NaCl
©2010 Jones and Bartlett Publishers