Study Guide for the Final (PHARM)
Ibuprofen
1.) Ibuprofen/similar drugs: diclofanc (Cambia, Volatren, Zipsor), diflunisal, etodolac,
fenoprofen(Nalfon), flurbiprofen (ocufen), ibuprofen (Advil, Motrin, others),
indomethacin (Indocin, Tivorbex) ketoprofen (Actron, Orudis), ketorolac (Toradol),
mefenamic acid (Ponstel), meloxicam (Mobic), nabumetone (Relafen), naproxen
(Naprelan, Naprosyn), naproxen sodium (Aleve, Anaprox, others), oxaprozin (Daypro),
piroxicam (Feldene), sulindac (Clinoril), tolmetin (Tolectin)
Adverse effects: indigestion, tinnitus, rash, pruritus, increased liver enzymes, nausea,
heartburn, epigastric pain, occult blood loss, anorexia, headache, drowsiness,
dizziness. Aplastic anemia, drug-induced peptic ulcer, GI bleeding, agranulocytosis,
laryngospasm, laryngeal edema, peripheral edema, aplastic anemia, anaphylaxis,
acute kidney injury, MI, Heart failure, hepatotoxicity, vomiting, constipation,
diarrhea
Ibuprofen (Advil, Motrin) (PROTOTYPE) – give drug on empty stomach if tolerated. Give with
food with nausea, vomiting, abdominal pain.
- Onset: 30-60 mins. PEAK: 1-2h. Duration: 4-6 hr
- Contraindications: CKD, hepatic impairment, nasal polyps, angioedema, bronchospasm,
HF, HTN, stroke, MI
- Drug-drug: NSAIDs, alcohol, corticosteroids are can adverse GI events. Aspirin can
decrease anti inflammatory action. Antihypertensive actions of diuretics, betablockers,
and ACE inhibs may be reduced. Feverfew, garlic, ginger, gingko may increase bleeding
- Treatment of Overdose: alkaline drug increase urinary excretion of ibuprofen
Antibiotic therapy
Look it up
Sulfamethoxazole
Sulfonamides CPR
- Effective against susceptible UTIs. Bacteriostatic (inhibits folic acid synthesis) and active
against broad spectrum of microorganisms. A.K.A folic acid inhibitors. Treats
pneumocystits carinii pneumonia/shigella infections of small bowel. Used for system
infections, topic uses, combination antibiotics
- Urinary sceptics: PO drugs for UTI (specific to system)
, - Sulfadiazine, sulfadoxine-pyrimethamine(Fansidar), sulfisoxazole(Gantrisin),
trimethoprim(TMP)-sulfamethoxazole(SMZ) (Bactrim/Septra)
- Adverse: anorexia, crystalluria (crystal in urine), nausea, photosensitivity, rash, vomit
(anaphylaxis, blood dyscrasias, fulminant hepatic necrosis, hypersensitivity reactions
hyperkalemia, SJS) (CPR)
- At first sign of rash, stop drug, contact provider (can indicate SJS). Watch for CKD.
Trimethoprim-Sulfamethoxazole(Bactrim) – sulfonamides
- Indicated for UTI. Synergistic against folic acid. Resistance is low.
- Alerts: oral doses w water
- Adverse: n/v, hypersensitivity (rash, itching, fever), caution in CKD (due to crystal
formation in urine)
- Contra: previous allergy to it, anemias related to folate, pregnancy (crosses barrier),
decrease K excretion (cardiac issues)
- Interactions: enhances anticoagulants, decrease phenytoin.
Loperamide
Look it up. OTC drug, loperamide (Imodium A-D), used for diarrhea (anti-diarrheal). Can be
given with Pepto. Anti-diarrhea medication should not be used when the cause is
toxic/poisonous organisms. Can cause paralytic ileus with toxic megacolon.
Nystatin
- Drugs for superficial mycoses: butenafine(Mentax), ciclopirox(loprox), griseofulvin(Gris-
PEG), naftifine(Naftin), nayamycin(Nayacyn), nystatin(Nystop), tavaborole(Kerydin),
terbinafine(Lamisil), tolnaftate(Aflate, Tinactin), undecylenic acid(Fungi-Nail). Topical
drugs may last 48 weeks, while PO last only 12 weeks. Topically is safer than systemic, as
only small amounts of absorbed.
Nystatin (Nystop) PROTO TYPE – superficial antifungal/polyene
- Binds to sterols in fungal cell membrane, cause leakage of intracellular contents –
membranes weaken. Same chemical class as amphotericin B but available in wide
varieties includes cream, ointment, powder, tablet, lozenge. PO available for
oral/intestinal fungal infections. Too toxic for parental admin.
- Used topically for Candida infections of vagina, skin, mouth. PO suspensions treats
oropharyngeal candidiasis (swish-shallow technique) and intestine candidiasis
- Alerts: Oral candidiasis in infants/children apply swab to affected area (swishing is
difficult). Adults should swish at least 2 mins. Preg C (oral) Preg A (topical)
- Adverse: topically: minor skin irritation, contact dermatitis. For PO: diarrhea, nausea,
vomit.
, - Contra: previous allergies
- Application of topical ointment: check order, dry skin, allow cream to dry before replace
clothing, wash old cream, apply thin layer of cream to area
Famotidine
H2-Receptor Antagonists (-tidine)
- Treatment for PUD. Effective at suppressing volume/acidity of parietal cell secretions.
- Cimetidine(Tagamet), famotidine(Pepcid), nizatidine(Axid), ranitidine(Zantac)
- Headache, nausea, dry mouth [rare: musculoskeletal pain, tachycardia, blood dyscrasia,
blurred vision]
- Histamine has H1 & H2 receptors
H1: activation of H1 causes inflammation, allergy symptoms
H2: increasing acid secretion in the stomach
- Patients taking High doses or those with CKD or liver disease may experience confusion,
restlessness, hallucinations, or depression CDH
- Do not take with antacids at the same time because they will diminish absorption of H2-
receptor antagonist
Ranitidine (antiulcer/H2-receptor antagonist – Prototype)
- Blocks H2 receptor in the stomach to decrease acid production. Administered once daily
(higher potency than cimetidine). is the prototype once a day give.
- Administration alerts: administer after meals and monitor kidney/liver function
- Adverse effects: are usually mid w/ headache is most common side effect
- Contraindications: hypersensitivity to H2-recetpors and OTC administration not for
children under 12
- Drug: smoking decreases effect of ranitidine
GASTROESOPHAGEAL REFLUX DISEASE (GERD)
- Acidic contents of the stomach move into the Esophagus.
- Causes heartburn, belching. If severe (& untreated), esophagitis, ulcers, or strictures
- Causes of GERD is Weakening of the lower esophageal sphincter (LES) – when LES does
not close tightly, results in stomach acid into the esophagus , resulting in heartburn.
- 10% develop Barret's esophagus => a condition of increased risk of esophageal cancer
- Also associated with obesity so losing weight may improve symptoms, elevating head of
bed, avoid fatty or acidic foods, eating smaller meals at least 3 hrs before sleep and
eliminating tobacco and alcohol use.
, Benadryl
H1-Receptor Antagonists
- First generation (significant drowsiness)
Brompheniramine(Dimetapp), chlorpheniramine(Chlor-Trimeton), clemastine
(Tavist-1), cyproheptadine, dexchlorpheniramine (Dexchlor, Poladex, Polaramine),
dimenhydrinate (Dramamine), diphenhydramine(Benadryl),
promethazine(Phenergan)
Adverse effects: dry mouth, dizziness, headache, thickening of bronchial secretions,
nausea, urinary retention, vomiting DDUNT HV(paradoxical excitation, sedation,
hypersensitivity reactions, hypotension, EPS [promethazine],
agranulocytosis[brompheniramine/prometh], respiratory depression) REPS
Diphenhydramine/clemastine: 1st gen produce greatest incidence of anticholinergic
(Ac) side effects
Complications (1st gen): sedation (take at night, avoid activities that require
alertness, no alcohol, other CNS depressants). Anticholinergic effects more common
w 1st gen. GI discomfort (take w meals if nec). Toxicity, excitation, hallucinations,
incoordination, seizure in kids. Flushed face, high fever, tachycardia, urinary
retention, pupil dilation. HE SITT - PUFF
Treatment: Activated charcoal for decreased absorption. Ice packs, Tylenol for fever
No relief of nasal congestion
Diphenhydramine (Benadryl) PROTOTYPE
- Therapeutic class: drug to treat allergies.
- Pharmacologic class: H1-receptor antagonist, antihistamine
- Actions: first generation to treat minor symptoms of allergy/common cold (sneezing,
runny nose, tearing of eyes SRT). Combined w analgesics, decongestant, expectorant in
OTC cold/flu products. Administered topically to treat rashes. IM/IV available for severe
allergic reactions. Used for Parkinson’s disease, motion sickness, insomnia.
- Alerts: increase risk of anaphylactic shock when administered parentally. IV, inject at
rate of 25 mg/min to reduce risk of shock. IM, inject deep in large muscle to minimize
tissue irritation. Preg C.
Ibuprofen
1.) Ibuprofen/similar drugs: diclofanc (Cambia, Volatren, Zipsor), diflunisal, etodolac,
fenoprofen(Nalfon), flurbiprofen (ocufen), ibuprofen (Advil, Motrin, others),
indomethacin (Indocin, Tivorbex) ketoprofen (Actron, Orudis), ketorolac (Toradol),
mefenamic acid (Ponstel), meloxicam (Mobic), nabumetone (Relafen), naproxen
(Naprelan, Naprosyn), naproxen sodium (Aleve, Anaprox, others), oxaprozin (Daypro),
piroxicam (Feldene), sulindac (Clinoril), tolmetin (Tolectin)
Adverse effects: indigestion, tinnitus, rash, pruritus, increased liver enzymes, nausea,
heartburn, epigastric pain, occult blood loss, anorexia, headache, drowsiness,
dizziness. Aplastic anemia, drug-induced peptic ulcer, GI bleeding, agranulocytosis,
laryngospasm, laryngeal edema, peripheral edema, aplastic anemia, anaphylaxis,
acute kidney injury, MI, Heart failure, hepatotoxicity, vomiting, constipation,
diarrhea
Ibuprofen (Advil, Motrin) (PROTOTYPE) – give drug on empty stomach if tolerated. Give with
food with nausea, vomiting, abdominal pain.
- Onset: 30-60 mins. PEAK: 1-2h. Duration: 4-6 hr
- Contraindications: CKD, hepatic impairment, nasal polyps, angioedema, bronchospasm,
HF, HTN, stroke, MI
- Drug-drug: NSAIDs, alcohol, corticosteroids are can adverse GI events. Aspirin can
decrease anti inflammatory action. Antihypertensive actions of diuretics, betablockers,
and ACE inhibs may be reduced. Feverfew, garlic, ginger, gingko may increase bleeding
- Treatment of Overdose: alkaline drug increase urinary excretion of ibuprofen
Antibiotic therapy
Look it up
Sulfamethoxazole
Sulfonamides CPR
- Effective against susceptible UTIs. Bacteriostatic (inhibits folic acid synthesis) and active
against broad spectrum of microorganisms. A.K.A folic acid inhibitors. Treats
pneumocystits carinii pneumonia/shigella infections of small bowel. Used for system
infections, topic uses, combination antibiotics
- Urinary sceptics: PO drugs for UTI (specific to system)
, - Sulfadiazine, sulfadoxine-pyrimethamine(Fansidar), sulfisoxazole(Gantrisin),
trimethoprim(TMP)-sulfamethoxazole(SMZ) (Bactrim/Septra)
- Adverse: anorexia, crystalluria (crystal in urine), nausea, photosensitivity, rash, vomit
(anaphylaxis, blood dyscrasias, fulminant hepatic necrosis, hypersensitivity reactions
hyperkalemia, SJS) (CPR)
- At first sign of rash, stop drug, contact provider (can indicate SJS). Watch for CKD.
Trimethoprim-Sulfamethoxazole(Bactrim) – sulfonamides
- Indicated for UTI. Synergistic against folic acid. Resistance is low.
- Alerts: oral doses w water
- Adverse: n/v, hypersensitivity (rash, itching, fever), caution in CKD (due to crystal
formation in urine)
- Contra: previous allergy to it, anemias related to folate, pregnancy (crosses barrier),
decrease K excretion (cardiac issues)
- Interactions: enhances anticoagulants, decrease phenytoin.
Loperamide
Look it up. OTC drug, loperamide (Imodium A-D), used for diarrhea (anti-diarrheal). Can be
given with Pepto. Anti-diarrhea medication should not be used when the cause is
toxic/poisonous organisms. Can cause paralytic ileus with toxic megacolon.
Nystatin
- Drugs for superficial mycoses: butenafine(Mentax), ciclopirox(loprox), griseofulvin(Gris-
PEG), naftifine(Naftin), nayamycin(Nayacyn), nystatin(Nystop), tavaborole(Kerydin),
terbinafine(Lamisil), tolnaftate(Aflate, Tinactin), undecylenic acid(Fungi-Nail). Topical
drugs may last 48 weeks, while PO last only 12 weeks. Topically is safer than systemic, as
only small amounts of absorbed.
Nystatin (Nystop) PROTO TYPE – superficial antifungal/polyene
- Binds to sterols in fungal cell membrane, cause leakage of intracellular contents –
membranes weaken. Same chemical class as amphotericin B but available in wide
varieties includes cream, ointment, powder, tablet, lozenge. PO available for
oral/intestinal fungal infections. Too toxic for parental admin.
- Used topically for Candida infections of vagina, skin, mouth. PO suspensions treats
oropharyngeal candidiasis (swish-shallow technique) and intestine candidiasis
- Alerts: Oral candidiasis in infants/children apply swab to affected area (swishing is
difficult). Adults should swish at least 2 mins. Preg C (oral) Preg A (topical)
- Adverse: topically: minor skin irritation, contact dermatitis. For PO: diarrhea, nausea,
vomit.
, - Contra: previous allergies
- Application of topical ointment: check order, dry skin, allow cream to dry before replace
clothing, wash old cream, apply thin layer of cream to area
Famotidine
H2-Receptor Antagonists (-tidine)
- Treatment for PUD. Effective at suppressing volume/acidity of parietal cell secretions.
- Cimetidine(Tagamet), famotidine(Pepcid), nizatidine(Axid), ranitidine(Zantac)
- Headache, nausea, dry mouth [rare: musculoskeletal pain, tachycardia, blood dyscrasia,
blurred vision]
- Histamine has H1 & H2 receptors
H1: activation of H1 causes inflammation, allergy symptoms
H2: increasing acid secretion in the stomach
- Patients taking High doses or those with CKD or liver disease may experience confusion,
restlessness, hallucinations, or depression CDH
- Do not take with antacids at the same time because they will diminish absorption of H2-
receptor antagonist
Ranitidine (antiulcer/H2-receptor antagonist – Prototype)
- Blocks H2 receptor in the stomach to decrease acid production. Administered once daily
(higher potency than cimetidine). is the prototype once a day give.
- Administration alerts: administer after meals and monitor kidney/liver function
- Adverse effects: are usually mid w/ headache is most common side effect
- Contraindications: hypersensitivity to H2-recetpors and OTC administration not for
children under 12
- Drug: smoking decreases effect of ranitidine
GASTROESOPHAGEAL REFLUX DISEASE (GERD)
- Acidic contents of the stomach move into the Esophagus.
- Causes heartburn, belching. If severe (& untreated), esophagitis, ulcers, or strictures
- Causes of GERD is Weakening of the lower esophageal sphincter (LES) – when LES does
not close tightly, results in stomach acid into the esophagus , resulting in heartburn.
- 10% develop Barret's esophagus => a condition of increased risk of esophageal cancer
- Also associated with obesity so losing weight may improve symptoms, elevating head of
bed, avoid fatty or acidic foods, eating smaller meals at least 3 hrs before sleep and
eliminating tobacco and alcohol use.
, Benadryl
H1-Receptor Antagonists
- First generation (significant drowsiness)
Brompheniramine(Dimetapp), chlorpheniramine(Chlor-Trimeton), clemastine
(Tavist-1), cyproheptadine, dexchlorpheniramine (Dexchlor, Poladex, Polaramine),
dimenhydrinate (Dramamine), diphenhydramine(Benadryl),
promethazine(Phenergan)
Adverse effects: dry mouth, dizziness, headache, thickening of bronchial secretions,
nausea, urinary retention, vomiting DDUNT HV(paradoxical excitation, sedation,
hypersensitivity reactions, hypotension, EPS [promethazine],
agranulocytosis[brompheniramine/prometh], respiratory depression) REPS
Diphenhydramine/clemastine: 1st gen produce greatest incidence of anticholinergic
(Ac) side effects
Complications (1st gen): sedation (take at night, avoid activities that require
alertness, no alcohol, other CNS depressants). Anticholinergic effects more common
w 1st gen. GI discomfort (take w meals if nec). Toxicity, excitation, hallucinations,
incoordination, seizure in kids. Flushed face, high fever, tachycardia, urinary
retention, pupil dilation. HE SITT - PUFF
Treatment: Activated charcoal for decreased absorption. Ice packs, Tylenol for fever
No relief of nasal congestion
Diphenhydramine (Benadryl) PROTOTYPE
- Therapeutic class: drug to treat allergies.
- Pharmacologic class: H1-receptor antagonist, antihistamine
- Actions: first generation to treat minor symptoms of allergy/common cold (sneezing,
runny nose, tearing of eyes SRT). Combined w analgesics, decongestant, expectorant in
OTC cold/flu products. Administered topically to treat rashes. IM/IV available for severe
allergic reactions. Used for Parkinson’s disease, motion sickness, insomnia.
- Alerts: increase risk of anaphylactic shock when administered parentally. IV, inject at
rate of 25 mg/min to reduce risk of shock. IM, inject deep in large muscle to minimize
tissue irritation. Preg C.
