NURS8024 Pharm Exam 1
*Antifungal treatment must be - ANS-*long enough for complete turnover of skin*
-If treatment is not sufficient duration infection recurs*
Oral agents often needed for fungal nail infection
\2 kinds of drug contraindications - ANS-Absolute
Relative
\2 Major drug administration routes - ANS-Enteral
Parenteral
\25% of the elderly - ANS-are taking inappropriate medications
\3 steps to treatment of peptic ulcer disease - ANS-1) eradicating the H. pylori infection
2) reduction of gastric acid secretion (H2blockers and PPIs)
3) agents that protect gastric mucosa from damage (misoprostol and sucralfate)
\4 Fundamental pathways for a drug - ANS-Absorption
Distribution
Metabolism
Elimination
(ADME)
\4 Major variables determining pharmacologic response to drugs applied to the skin include -
ANS-1. Regional variation in drug penetration
2. Concentration Gradient
3. Dosing Schedule
4. Vehicles and Occlusion
\6 factors affecting placental drug transfer and fetal effects include - ANS-1.Physicochemical
properties of the drug
2. Rate at which the drug crosses the placenta and the amount of drug reaching the fetus
3. Duration of exposure to the drug
4. Distribution characteristics in different fetal tissues
5. Stage of placental and fetal development at the time of exposure to the drug
6. Effects of drugs used in combination
\A decline in hepatic blood flow, enzyme production, biotransformation, and phase I oxidation
reactions in the liver of the elderly causes - ANS-reduction in metabolism of some drugs, ↑
half-life & risk of ADRs/Toxicities
\A decrease in total body water in the elderly will cause - ANS-increasing concentrations of
water-soluble drugs
\A large volume of distribution will effect - ANS-half-life of the drug
\A more variable drug effect on CNS in the elderly is due to - ANS-• r/t ↓ blood supply,
changes in the blood-brain barrier (allowing fatsoluble drugs to permeate the brain),
•↓ in acetylcholine, dopamine, and serotonin
→ potentiating ADRs
\Absolute Contraindications - ANS-situations in which a medication should never be given if
the contraindication is present
\Absorption - ANS-Entry of pharmacological agent into plasma
,\Absorption/Action of PPIs - ANS-*Coating is removed* in the alkaline duodenum, and the
prodrug, a weak base, is absorbed and transported to the parietal cell canaliculus →
Converted to the active form
All PPIs inhibit both basal and stimulated gastric acid secretion by > 90%
• Onset of gastric acid suppression w/i 1 to 2 hrs post first dose of lansoprazole and slightly
earlier with omeprazole
\Acid secretion, blood flow, and GI tract motility
↓ and pH level ↑ possibly causes - ANS-reduced drug absorption
\Acitretin (Soriatane) - ANS-Retinoid derivative, similar ADE as isotretinoin
- *BBW - for blood donation and pregnancy prohibited during Tx and 3 yrs after!*
- No ETOH- forms teratogen w/ longer half-life
\Acne Pathogenesis and drug mechanisms - ANS-
\Acne Treatment Considerations - ANS-• Severity
• Lesions-
non-inflammatory or inflammatory
• Treatment preferences
• Cost implications
Patient Age
• Skin type
• Adherence
• Response to previous therapy
• Presence of scarring
• Psychologic effects
• Family history of persistent acne
\Acute ulcerative blepharitis - ANS-inflammation/infectious processes of the lids
\Acyclovir, Valacyclovir, penciclovir and famciclovir inhibitory against - ANS-herpes viruses
\Additional Adverse Drug Effect categories - ANS-• Augmented effects- hypotension w/
propanolol
• Bizarre effects - Angioedema w/ACEI
• Chronic effects -tremors from cyclosporin
• Delayed effects-cardiomyopathy from adriomycin,
"moon facies" w/ steroid use
• End of Treatment effects- hypertensive crisis from
stopping clonidine, adrenocortical insufficiency
secondary to abrupt withdraw of steroids
\Additive effect - ANS-When 2 drugs w/ similar action taken together and combined
effect is summative (1+1=2)
\Adolescent age criteria - ANS->12 years
\Adsorbents - - ANS-Kaopectate; *Kaolin (naturally occurring hydrated magnesium aluminum
silicate), combined with *pectin (indigestible carbohydrate derived from
apples)
• absorbs bacterial toxins and fluid in infectious diarrhea
• → decreased stool liquidity
• Reduce motility and adsorbs fluid
\Adverse Drug Reaction or Event (ADR, AE) - ANS-Any response that is unfavorable or
unintended and occurs with normal dose
\Adverse effects of antacids - ANS-• Aluminum hydroxide tends to be constipating
,• Magnesium hydroxide tends to cause diarrhea
• Binding of phosphate by aluminum-containing antacids → hypophosphatemia
• Sodium bicarbonate → belching and flatulence, potential for systemic alkalosis
• Sodium content of antacids → can be important in pts w/ HTN or CHF
• Excessive intake of calcium carbonate along w/ calcium foods → hypercalcemia
\Adverse effects of Minoxidil (Rogaine) - ANS-• Allergic and irritant contact dermatitis
• Hair growth in undesirable locations - reversible on stopping the drug
• Patients instructed to wash hands after applying
• Percutaneous absorption of minoxidil minimal in normal scalp - possible systemic effects
on blood pressure
\Adverse Events that are both serious and unexpected should be reported to the FDA within
- ANS-15 days
\Adverse local effects of topical corticosteroids - ANS-Atrophy-shiny, depressed, wrinkled
appearing skin with prominent telangiectasia
-Purpura and ecchymosis
- Telangiectatic vessels, pustules, and papules
-Perioral dermatitis
- Steroid acne
- hypopigmentation
- Hypertrichosis
- Increased intraocular pressure
- worsening of cutaneous infections
\Adverse local reactions caused by acyclovir or penciclovir - ANS-Pruritus and mild pain with
transient stinging and burning
\Adverse systemic effects of topical corticosteroids - ANS-• All absorbable topical
corticosteroids have potential to suppress Hypothalamic Pituitary adrenal (HPA) axis
• Iatrogenic Cushing's syndrome can occur as a result of long term use of topical
corticosteroids in large quantities
• Steroid induced glaucoma/cataracts
* Adverse systemic effects in children-may take lesser amt/duration for ADE- growth
retardation possible
• Pregnancy -caution advised-esp. 1st trimester
• Geriatric patients more susceptible to secondary infection
\Advise for prescribers based on malpractice litigation - ANS-• Write clearly or have
electronic system
• If suicidal ideation- no more than 7 days of any medication
that can be lethal OD
• Warn about side effects
• Discontinue if SE occurs
• Informed consent if drug has potential for permanent,
serious SE
• Document rationale for "off label" prescribing
• Monitor for known long term effects
• (if drug has to be continued)
• Ask, listen, alter the plan
\Age Related changes that influence drug response - ANS-• Orthostatic hypotension
, • Bowel, bladder- Urinary retention, constipation, BPH
• Impaired thermoregulation
• Reduced cognition
• Postural instability
• Glucose intolerance
\Agents for Seborrheic Dermatitis - ANS-
\Agents for Treatment of Pruritis - ANS-
\Alosetron (Lotronex) - ANS-• 5-HT3 receptor antagonist
• MOA- reduces smooth muscle activity in GI tract
• Used in severe diarrhea-predominant IBS in women
• Black Box warning- rare, serious constipation, ischemic colitis, bowel infarction
• $$$$
\An Age-related ↓ in serum albumin concentrations and drug binding can be exacerbated by
disease & malnutrition resulting in - ANS-increased concentrations of the active drug
\Anaphylaxis - ANS-Severe hypersensitivity reaction
Antigen-antibody reaction that occurs on mast cells
IgE
\Antacids - ANS-weak bases that react with gastric acid to
form water and a salt → diminishing gastric acidity
Reduce pepsin activity - pepsin inactive at a pH >4
Wide variety* in chemical composition, acid-neutralizing capacity, sodium content,
palatability, and price
Acid neutralizing ability* of an antacid depends on its capacity to neutralize gastric HCl and
on whether the stomach is full or empty
• food delays stomach emptying, allowing more time for the antacid to react
\Antacids during pregnancy and lactation - ANS-No FDA category established, although
antacids
generally are considered safe for use in pregnancy
\Antacids in Pediatrics - ANS-Safety not established in children
\anti-diarrheal drugs include - ANS-antimotility agents, adsorbents, & drugs that modify fluid
and electrolyte transport
\Anti-diarrheal drugs should not be used - ANS-in patients w/ bloody diarrhea, high fever, or
systemic toxicity
\Anti-Inflammatory Agents-Corticosteroids - ANS-• Efficacy of topical corticosteroids for tx
inflammatory dermatoses
• Numerous types available w/ choices of potencies, concentrations, and vehicles
• Anti-inflammatory and antimitotic effects
• Original-hydrocortisone
*Therapeutic effectiveness -based primarily on their anti-inflammatory activity*
\Anti-viral infections of the skin - ANS-Human Papillomavirus (HPV)
Herpes Simplex (HSV)
Condyloma acuminatum (HPV)
molluscum contagiosum (poxvirus)
chicken pox (varicella-zoster virus)
*Antifungal treatment must be - ANS-*long enough for complete turnover of skin*
-If treatment is not sufficient duration infection recurs*
Oral agents often needed for fungal nail infection
\2 kinds of drug contraindications - ANS-Absolute
Relative
\2 Major drug administration routes - ANS-Enteral
Parenteral
\25% of the elderly - ANS-are taking inappropriate medications
\3 steps to treatment of peptic ulcer disease - ANS-1) eradicating the H. pylori infection
2) reduction of gastric acid secretion (H2blockers and PPIs)
3) agents that protect gastric mucosa from damage (misoprostol and sucralfate)
\4 Fundamental pathways for a drug - ANS-Absorption
Distribution
Metabolism
Elimination
(ADME)
\4 Major variables determining pharmacologic response to drugs applied to the skin include -
ANS-1. Regional variation in drug penetration
2. Concentration Gradient
3. Dosing Schedule
4. Vehicles and Occlusion
\6 factors affecting placental drug transfer and fetal effects include - ANS-1.Physicochemical
properties of the drug
2. Rate at which the drug crosses the placenta and the amount of drug reaching the fetus
3. Duration of exposure to the drug
4. Distribution characteristics in different fetal tissues
5. Stage of placental and fetal development at the time of exposure to the drug
6. Effects of drugs used in combination
\A decline in hepatic blood flow, enzyme production, biotransformation, and phase I oxidation
reactions in the liver of the elderly causes - ANS-reduction in metabolism of some drugs, ↑
half-life & risk of ADRs/Toxicities
\A decrease in total body water in the elderly will cause - ANS-increasing concentrations of
water-soluble drugs
\A large volume of distribution will effect - ANS-half-life of the drug
\A more variable drug effect on CNS in the elderly is due to - ANS-• r/t ↓ blood supply,
changes in the blood-brain barrier (allowing fatsoluble drugs to permeate the brain),
•↓ in acetylcholine, dopamine, and serotonin
→ potentiating ADRs
\Absolute Contraindications - ANS-situations in which a medication should never be given if
the contraindication is present
\Absorption - ANS-Entry of pharmacological agent into plasma
,\Absorption/Action of PPIs - ANS-*Coating is removed* in the alkaline duodenum, and the
prodrug, a weak base, is absorbed and transported to the parietal cell canaliculus →
Converted to the active form
All PPIs inhibit both basal and stimulated gastric acid secretion by > 90%
• Onset of gastric acid suppression w/i 1 to 2 hrs post first dose of lansoprazole and slightly
earlier with omeprazole
\Acid secretion, blood flow, and GI tract motility
↓ and pH level ↑ possibly causes - ANS-reduced drug absorption
\Acitretin (Soriatane) - ANS-Retinoid derivative, similar ADE as isotretinoin
- *BBW - for blood donation and pregnancy prohibited during Tx and 3 yrs after!*
- No ETOH- forms teratogen w/ longer half-life
\Acne Pathogenesis and drug mechanisms - ANS-
\Acne Treatment Considerations - ANS-• Severity
• Lesions-
non-inflammatory or inflammatory
• Treatment preferences
• Cost implications
Patient Age
• Skin type
• Adherence
• Response to previous therapy
• Presence of scarring
• Psychologic effects
• Family history of persistent acne
\Acute ulcerative blepharitis - ANS-inflammation/infectious processes of the lids
\Acyclovir, Valacyclovir, penciclovir and famciclovir inhibitory against - ANS-herpes viruses
\Additional Adverse Drug Effect categories - ANS-• Augmented effects- hypotension w/
propanolol
• Bizarre effects - Angioedema w/ACEI
• Chronic effects -tremors from cyclosporin
• Delayed effects-cardiomyopathy from adriomycin,
"moon facies" w/ steroid use
• End of Treatment effects- hypertensive crisis from
stopping clonidine, adrenocortical insufficiency
secondary to abrupt withdraw of steroids
\Additive effect - ANS-When 2 drugs w/ similar action taken together and combined
effect is summative (1+1=2)
\Adolescent age criteria - ANS->12 years
\Adsorbents - - ANS-Kaopectate; *Kaolin (naturally occurring hydrated magnesium aluminum
silicate), combined with *pectin (indigestible carbohydrate derived from
apples)
• absorbs bacterial toxins and fluid in infectious diarrhea
• → decreased stool liquidity
• Reduce motility and adsorbs fluid
\Adverse Drug Reaction or Event (ADR, AE) - ANS-Any response that is unfavorable or
unintended and occurs with normal dose
\Adverse effects of antacids - ANS-• Aluminum hydroxide tends to be constipating
,• Magnesium hydroxide tends to cause diarrhea
• Binding of phosphate by aluminum-containing antacids → hypophosphatemia
• Sodium bicarbonate → belching and flatulence, potential for systemic alkalosis
• Sodium content of antacids → can be important in pts w/ HTN or CHF
• Excessive intake of calcium carbonate along w/ calcium foods → hypercalcemia
\Adverse effects of Minoxidil (Rogaine) - ANS-• Allergic and irritant contact dermatitis
• Hair growth in undesirable locations - reversible on stopping the drug
• Patients instructed to wash hands after applying
• Percutaneous absorption of minoxidil minimal in normal scalp - possible systemic effects
on blood pressure
\Adverse Events that are both serious and unexpected should be reported to the FDA within
- ANS-15 days
\Adverse local effects of topical corticosteroids - ANS-Atrophy-shiny, depressed, wrinkled
appearing skin with prominent telangiectasia
-Purpura and ecchymosis
- Telangiectatic vessels, pustules, and papules
-Perioral dermatitis
- Steroid acne
- hypopigmentation
- Hypertrichosis
- Increased intraocular pressure
- worsening of cutaneous infections
\Adverse local reactions caused by acyclovir or penciclovir - ANS-Pruritus and mild pain with
transient stinging and burning
\Adverse systemic effects of topical corticosteroids - ANS-• All absorbable topical
corticosteroids have potential to suppress Hypothalamic Pituitary adrenal (HPA) axis
• Iatrogenic Cushing's syndrome can occur as a result of long term use of topical
corticosteroids in large quantities
• Steroid induced glaucoma/cataracts
* Adverse systemic effects in children-may take lesser amt/duration for ADE- growth
retardation possible
• Pregnancy -caution advised-esp. 1st trimester
• Geriatric patients more susceptible to secondary infection
\Advise for prescribers based on malpractice litigation - ANS-• Write clearly or have
electronic system
• If suicidal ideation- no more than 7 days of any medication
that can be lethal OD
• Warn about side effects
• Discontinue if SE occurs
• Informed consent if drug has potential for permanent,
serious SE
• Document rationale for "off label" prescribing
• Monitor for known long term effects
• (if drug has to be continued)
• Ask, listen, alter the plan
\Age Related changes that influence drug response - ANS-• Orthostatic hypotension
, • Bowel, bladder- Urinary retention, constipation, BPH
• Impaired thermoregulation
• Reduced cognition
• Postural instability
• Glucose intolerance
\Agents for Seborrheic Dermatitis - ANS-
\Agents for Treatment of Pruritis - ANS-
\Alosetron (Lotronex) - ANS-• 5-HT3 receptor antagonist
• MOA- reduces smooth muscle activity in GI tract
• Used in severe diarrhea-predominant IBS in women
• Black Box warning- rare, serious constipation, ischemic colitis, bowel infarction
• $$$$
\An Age-related ↓ in serum albumin concentrations and drug binding can be exacerbated by
disease & malnutrition resulting in - ANS-increased concentrations of the active drug
\Anaphylaxis - ANS-Severe hypersensitivity reaction
Antigen-antibody reaction that occurs on mast cells
IgE
\Antacids - ANS-weak bases that react with gastric acid to
form water and a salt → diminishing gastric acidity
Reduce pepsin activity - pepsin inactive at a pH >4
Wide variety* in chemical composition, acid-neutralizing capacity, sodium content,
palatability, and price
Acid neutralizing ability* of an antacid depends on its capacity to neutralize gastric HCl and
on whether the stomach is full or empty
• food delays stomach emptying, allowing more time for the antacid to react
\Antacids during pregnancy and lactation - ANS-No FDA category established, although
antacids
generally are considered safe for use in pregnancy
\Antacids in Pediatrics - ANS-Safety not established in children
\anti-diarrheal drugs include - ANS-antimotility agents, adsorbents, & drugs that modify fluid
and electrolyte transport
\Anti-diarrheal drugs should not be used - ANS-in patients w/ bloody diarrhea, high fever, or
systemic toxicity
\Anti-Inflammatory Agents-Corticosteroids - ANS-• Efficacy of topical corticosteroids for tx
inflammatory dermatoses
• Numerous types available w/ choices of potencies, concentrations, and vehicles
• Anti-inflammatory and antimitotic effects
• Original-hydrocortisone
*Therapeutic effectiveness -based primarily on their anti-inflammatory activity*
\Anti-viral infections of the skin - ANS-Human Papillomavirus (HPV)
Herpes Simplex (HSV)
Condyloma acuminatum (HPV)
molluscum contagiosum (poxvirus)
chicken pox (varicella-zoster virus)
