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FNP Intensive Review: Pharmacology
Terms in this set (92)
Tetracycline: may cause permanent discoloration of teeth, if taken during the last half of pregnancy, in infancy, or by children less than 8 years of age.
Doxycycline PO BID first line chlamydial and atypical bacterial infection
Minocycline has more side effects and adverse effects (vertigo and dozziness)
tetracycline first -line moderate to severe acne, rosacea
Tetracycline: adverse effect
Photosensitivity, Esophageal ulceration
use topical benzamycin, Retin-A
Tetracycline first -line for moderate to severe acne, rosacea
if not better after 2-3 month of topical benzamycin, Retin-A use
Tetracycline may decrease effectiveness of
Macrolides (preg cat B)
Erythromycin (cat B) clarithromycin (cat c) , both are potent CYP 34A inhibitor high drug interaction
Azithromycin (Cat B) fewer drug interaction
Macrolides: side effects
GI distress especially with erythromycin so switch to azithromycin
ototoxixity, cholestatic jaundice, QT prolongation
Cephalosporins first generation (G+ve)
cephalexin (Keflex) PO QID
Pregnancy: UTI (if sensitive)
skin: impetigo, cellulitis, Mastitis
Cephalosporins Second generation (G -ve/G+ve)
Cefuroxime axetil (ceftin) PO BID
Cefprozil (cefzil) PO BID
Cefaclor (Ceclor)PO BID
ENT: sinisitis, Otitis media
Respiratory: CAP, exacerbation chronic bronchitis
Other: AOM, Sinisitis, Skin infection
Cephalosporins Third generation (G-ve)
Cefriaxone (Rocephin) IM
Cefixime (Suprax) daily to BID
Cefdinir (Omnicef) daily to BID
STD: Gonorrhea cervicitis, Urethritis, PID
ENT: AOM in children, acute sinusitis, otitis media
GU: Pyelonephritis, CAP
Penicilline V Po QID
Strep throat first line
Amoxicilline BID to TID
Otitis media first line
Amoxcillin plus clavulanic acid (Augmentine PO BID)
Otitis media/Sinusitis (first to second line)
Benzathine penicilline G IM
syphillis first line
Dicloxacillin PO QID
Cellulitis (not caused by MRSA), impetigo, erysipelas, mastitis
some women will complain of candida vaginitis with amoxicillin
Rcommend probiotic capsules or eating yogurt daily
effective against gram negative bacteria and some atypical bacteria (chlamydia, mycoplasma, legionella)
Norfloxacin (Noroxin) BID
Ciprofloxacin (Cipro) BID
Ofloxacin (Floxin) BID
Broad-spectrum quinolones (G+ve/G-ve)
Levofloxacin (Levaquin) daily
Moxifloxacin (Avelox) daily
Gemifloxacin (Factive) daily
Respiratory Quinolones (excellent activity against strep pneumonia)
Levofloxacin (Levaquin) daily
Moxifloxacin (Avelox) daily
Drug interaction with Fluoroquinolones (Quinolones)
Avoid concmitant use of quinolones with QT prolonging drugs such as amiodrone, macrolides, TCAs antipsychotics. or with electrolyte imbalance hypomagnesemia, hypokalemia, since these will elevate the risk od sudden death from arrhythmias (torsades de pointes)
Coadministration Fluoroquinolones (Quinolones) with
aluminum, magnesium, calcium or sucralfate drastically reduces effectiveness of Fluoroquinolones (Quinolones)
Fluoroquinolones (Quinolones) is contraindication to
children < 18 years of age.
pregnant women, breast feeding
Fluoroquinolones (Quinolones) adverse effect
CNS: dizziness, headache, mood change
Achilles tendon rupture
is a serious complication of Fluoroquinolones (Quinolones) therapy.
if a patient on Fluoroquinolones (Quinolones)reports a new onset of difficulty in walking
order an ultrasound to rule out Achilles tendon rupture and discontinue the medicine.
Cutaneous anthrax is treated with
ciprofloxacin 500 mg BID x 7-10 days
Bioterrorism -related inhalation of anthrax is treated with
ciprofloxacin 500 mg BID x 60 days
Traveler's diarrhea is treated with
ciprofloxacin 500 mg BID x 3 days
Sulfonamides (preg cat. C)
TMP-SMX (Bactrim, septra)
firts line treatment for MRSA (G-ve)
Patient with a UTI who are on coumadin should not be given bactrim
increase risk of bleeding
Pregnant women with a UTI can be treated with
amoxicillin or cephalosporins
Ofloxacin (floxin) BID
UTIs, pyelonephritis, epididymitis, prostatitis
topical formulation (quinolones)
floxin otic (gtts)
Ocuglox ophthalmic (gtts)
OM with perforated TM, otitis externa
Hiv patient are at high risk (25 -50%) for
Sulfa-related Stevens-Johnson syndrome.
Short-term use of topical nasal decongestants (BID PRN x 3 days) is
considered safe treatment for nasal congestion (common cold, allergic rhinitis).
Rhinitis medicamentosa is due to
Chronic use (greater than 3 days) of nasal decongestants.
antihistamin (OTC drugs):
Diphenhydramine (Benadryl), Loratadine (claritin), cetrizine (Zyrtec)
Avoid using Benadryl with the elderly
for elderly patients, use loratadine(claritin) since it has a lower incidence of sedation.
zyrtec is more potent and long acting. it is very effective for acute and chronic urticaria.
Cold, cough and/or sinus medicines (OTC drugs)
Pseudoephedrine (sudafed), Phenylephrine
Dextromethorphan (rubitussin, delsym), benzonate (Tessalon)
Congestants contraindicated with
Hypertension, CAD (angina, MI)
Avoid mixing decongestants with other
stimulants like caffein, ritaline since they can elevate blood pressure and cause palpitations, arrthymias, tremors, and anxiety.
Dextromethorphan is contraindicated
within 14 days of MAOI and seligiline (Eldepryl)
Naproxen (Naprosyn, anaprox), diclofenac (voltaren) oral and topical gel
indmethacin (indocin), Ketoprofen (Orudis), ketorolac (Toradol)
Cox-2 inhibitors: celecoxib (celebrex)
should be avoided in heart failure disease, GI bleeding, severe renal disease.
Ketorolac (Toradol) IM, IV or tablet is short term use
only up to 5 days
Ketorolac (Toradol) contraindication:
should not be used before surgery, with concurrent ASA, pediatric patients, active or recent GI bleed, stroke, labor/delivery, and others.
COX-2 inhibitors (celecoxib) have
lower risk of GI bleeding compared to with other NSAIDs
For long term use of NSAIDs
Consider prescribing concurrent PPIs, H2-receptor antagonists, or misprostol (cytotec). Cytotec is synthetic protaglandin.
Aspirin irreversibly suppresses
platelet function for up to 7 days
discontinue ASA if
Patient complains of tinnitus (possible toxicity)
ASA given post-MI or after TIA is considered
Avoid using aspirin in children with viral infections who are less than 16 years of age
Risk of Reye's syndrome
Maximum dose up to 4 g/day or 1000 mg 0r 650 mg every 4 hours
Avoid Acetaminophen (tylenol) If
Chroninc hepatitis B/C/D, dehydration, liver disease, cirrosis, heavy drinker (acoholic)
First line drug for pain from osteoarthritis
antidote of Acetaminophen (tylenol) overdose
Rheumatoid arthritis and other autoimmune disorders.
Polymyalgia rheumatica (dramatic relief of symptoms)
Asthma or acute asthmatic exacerbations
Temporal arteritis (high doses x several weeks to months) and uveitis
skin (eczema, contact dermatitis
Prednisone 40 to 60 mg/day (high-dosed) for 3-4 days. can be used for short term treatment (i.e. asthma exacerbation).
class 1: super potent to class 7 least potent
Clss 1: clobetasol (temovate)
potent- halocinonide (halog)
moderate --Triamcinolone (kenalog)
Least potent (class 7)-- hydrocortisone
use low potency steroid for
Children, and on the face, intertriginous areas, and the ginitals eg: hydrocortisone 1% cream (OTC) to treat rashes on the face. may need to use opthalmic-grade ointments for rashes around the eyes/eyelids
use moderate to high potency steroids for
thicker skin (scalp, soles of feet, palms of hand) or for plaques (psoriasis). Taper topical steroids (or will rebound).
Acutely inflamed joints (knees/hips/shouldeers/elbows) can be treated with
intraarticular triamcinolone (kenalog) injection up to 3 times per year.
Do not inject steroids
side effects of glucocorticoids/steroids (chronic use)
HPA (hypothalamic pituitary-axis) suppression
cushing's dosease (dorsal hump, rounded face etc)
Osteoporosis (advise weight-bearing exercise, vitamin D, calcium 1200 mg/day, bisphosphonates)
Immunosuppression ( increased risk of infection)
skin changes from long-term topical therapy (skin atrophy, striae, telangiectasia, acne)
A severe case of poison ivy or poison oak may require
14 to 21 days of oral steroids to clear.
Drugs that require eye examination
Digoxin (yellow to green vision, blurrred vision, halos if blood level too high)
Ethambutal and linezolid
Cataracts, glaucoma, optic neuritis
Viagra, cialis, levitra
Cataracts, blurred vision, ischemic optic neuropathy, others
Cataracts, decreased night vision, other
Acute angle-closure glaucoma, increased ICP, mydriasis
Neuropathy and permanent loss of vision
Available only by limited-access protocol in the united states
Black box warning: serious cardiac arrhythmias (ventricular fibrillation/tachycardia, torsades de pointes, prolongation of QT intervals). check 12 lead EKG at baseline.check serum electrolights and creatinine.
Theophylline drug interactions
Theophylline level (adults) 5 - 15 mcg/ml
Drug interactions (cimetidine, alprazolam, macrolides, flucoxamine, other)
Tapering or weaning drugs
Beta-blockers (Rebound hypertension or hypertensive crisis)
benzodiazepines (severe anxiety, insomnia, seizures, tremors)
Parosetine or paxil
antiarrythmics (reffer to cardiologist)
Antipsychotics and many others
Certain drugs that are used long term need to be tapered. abrupt discontinuation will cause the treated condition to flare up (exacerbation), rebound, and/or have adverse effects:
Illegal drug overdose
All of thses drugs will cause euphoria, sociability, talkativeness, more energy, need for less sleep or no sleep, anorexia, others.
The most common cause of death (cocaine,ecstasy, amphetamines) is
Hypertension, MI, sudden death, arrhythymias, seizures resulting in
respiratory arrest, stroke, other
Euphoria, sociability, more energy, decreased appettite, insomnia
Pupils become dilated. May cause midline nasal septum perforation and / or ulceration with chronic use
A powerful stimulant. colors look brighter. vivid dreams and hallucinations. Enlarged pupils. may cause dehydration (due to low sodium) if poor fluid intake.
Methamphetamines ("crystal meth")
Chronic use results in severe dental carries with loss of front teeth on the upper jaw and drastic weight loss. pupils appear constricted.
U.S. FDA Drug enforcement agency (DEA)
controlled substances act
List of FDA category x drugs
FDA catefory classifications
controlled substances act
Schedule I drug: heroin, ectasy/MDMA, PCPets
illegal to prescribe. No currently accepted medical use. High abuse potential.
Schedule II drugs
Demerol, Dilaudid, Oxycontin, cocain, amphetamines etc
Only the original prescription with the physician's signature (not stamped) is acceptable.
the total number of pills must be indicated, no refills are allowed.
Schedule III drugs
Tylenol with codeine, vicodin, anabolic steroids, testosterone etc
Schedule IV drugs
benzodiazapines, ambien, lunesta, soma etc
Schedule v drugs
Cough medicines with less than 200 mg of codeine, lomotil, lyrica
For all control substances
must have the prescriber's and the supervising physician's name/DEA number with the clinic address on the pad. Cannot be pre-dated or post-dated.
List of FDA category x drugs
Finasteride (proscar, propecia): reproductive aged or pregnant women should not handle crushed/broken finasteride tablets
warfarin sodium (caumadin)
Androgenic hormones: Birth control pills, HRT, testosterone
Live virus vaccines (Measles, rubella, varicella, rotavirus, flumist)
thilidomide, DES, Methimazole, and so on
Glucosamine (with or without chondroitin): osteoarthritis
Natural progesterone cream (from wild yam root extract): PMS symptoms (hot flashes)
Isoflavones (from soy beans): Estrogen-like effects.
Saw palmetto: Urinary symptoms of BPH
Kava kava, valerian roots: anxiety and insomnia
St.John's wort: for mild depression. do not use with SSRIs, MAOIs, sumatriptan, HIV protease inhibitors (Indinavir) other.
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