Ch 17 - Immune PHARM

B Cells

Memory cells

T Cells

Create cytokines

H1 Receptor Antagonist (Antihistamines)

Block histamine response

Relax respiratory, vascular, GI smooth muscle

Use cautiously in pt’s with glaucoma

SE: sedation, anticholinergic effects

Ex: Diphenhydramine (Benadryl), Loratadine (Claritin), Cetirizine (Zyrtec)

Glucocorticoids/Corticosteroids

Suppress body’s inflammatory response

Interaction: NSAIDs

SE: Bone loss, weight gain, hyperglycemia, hypokalemia, PUD

MUST TAPER

Ex: beclomethasone (beclovent), fluticasone (flovent), hydrocortisone, methylprednisolone, prednisone

Risks of long term steroid use

Suppress immune system, increasing infection risk

Moon face (too much cortisol)

Hyperglycemia (Be mindful of diabetics)

Nasal Decongestants

Dry secretions to alleviate nasal congestion by causing vasoconstriction in the nose

Typically used 3-5 days ONLY to prevent rebound

Tetrahydrozoline (Tyzine Nasal), Afrin

NSAIDs

Reduce inflammation without use of steroids; inhibiting prostaglandin synthesis

Contraindication: pregnancy, PUD, bleeding disorders

SE: GI upset, nephrotoxicity, can cause GI bleeding, increased risk of thombotic events

Ex: ibuprofen (advil/motrin), naproxen (aleve, naprosyn), diclofenac (zorvolex), celecoxib (celebrex), ketorolac (toradol)

Which NSAID is most used/common for severe pain?

Ketorolac (toradol) via IV

Why should NSAIDs not be a long term use?

Risk of ulcers and GI bleeding

Broad spectrum antibiotic that is effective against many types of bacteria?

Zosyn

Penicillins

Kill bacteria by destroying cell walls

Side effects: gi upset, c.diff, allergic reaction

CI: Allergies to penicillin or cephalosporins

Ex: ampicillin (omnipen), amoxicillin (amoxil), penicillin

Cephalosporins

Treat bacterial infections by weakening cell wall

CI: penicillin allergy

SE: GI upset, allergic reactions, superinfection

NO ALCOHOL

Ex: ceftriaxone (rocephin)

Aminoglycosides

Serious bacterial infections via inhibition of protein synthesis

SE: Ototoxicity, nephrotoxicity, neurotoxicity, vertigo, ataxia

Ex: Gentamicin (Garamycin)

Glycopeptides

For serious bacterial infections/antibiotic associated C.Diff via destruction of cell wall

SE: Ototoxicity, nephrotoxicity, or red man’s syndrome

NC: Monitor trough levels

Ex: Vancomycin

Macrolides

Bacterial infections via inhibition of protein synthesis

SE: GI upset, dysrhythmias, ototoxicity, rash

Ex: Azithromycin, erythromycin

Tetracyclines

Acne, lyme disease, STIs, Rocky Mountain spotty fever via protein synthesis inhibition

CI: pregnancy, children <8 due to the risk of tooth discoloration on fetus and children

SE: GI upset, photosensitivity, superinfection, hepatotoxicity, decreased efficacy of oral contraceptives

PT: NO dairy products, foods high in ca and iron

Ex: Doxycycline (Vibramycin)

Anti TB Agents

Bactericidal/Bacteriostatic for mycobacteria causing TB

SE: orange secretions, GI upset, decreased efficacy of oral contraceptives, hepatotoxicity

Ex: Rifampin (rifadin)

Systemic Antifungals

Systemic fungal infections

SE: TOXIC! Fever, chills, nausea/vomiting, nephrotoxicity, increased liver enzymes

NC: monitor liver dysfunction (pale stools, dark urine, jaundice)

Ex: Amphotericin B

Calcium inhibitors/Immunosuppressants

Prevention of organ rejection, UC, RA

SE: hepato/nephrotoxicity, HTN, tremor

Ex: Cyclosporin (Neoral)

Cox-2 Inhibitor

Decreasing pain and inflammation for Osteoarthritis, RA

CI: allergy to NSAIDs or sulfonamides

SE: Rash

Ex: Celecoxib (Celebrex)

Antimetabolites

Decrease swelling and pain, immunosuppression

SE: infection, hepatotoxicity, fetal death

Ex: Methotrexate

Extended Spectrum Penicillin

Moderate to severe bacterial infections

CI: Allergies to penicillins or cephalosporins

SE: Diarrhea, superinfection, allergic reaction, nephro/hepatotoxicity

Ex: Piperacillin (Zosyn)

Nitroimidazoles

Bacterial and protozoal infections

SE: GI upset, metallic taste, dark urine, headache

Ex: Metronidazole (Flagyl)

Carbapenem

For serious bacterial infections

CI: Allergy of penicillin or cephalosporin

SE: GI upset, rash, superinfection, seizures

Ex: Imipenem

Lincosamides

Serious bacterial infections

SE: GI upset, diarrhea, superinfection

Ex: Clindamycin (Cleocin)

Urinary Tract Antiseptic

UTI Treatment

SE: GI upset, pulmonary toxicity, peripheral neuropathy, brown discoloration of urine

PT: Take w food

Ex: Nitrofurantoin

Sulfonamides

Bacterial infections via inhibition of folic acid synthesis

CI: sulfa allergy

SE: GI upset, blood dyscrasias, photosensitivity, crystalluria, Stevens-Johnsons syndrome

PT: Increase fluid intake

Ex: Trimethoprim (Bactrim)

Fluoroquinolones

Bacterial infections

SE: Diarrhea, superinfection, photosensitivity, increased liver enzymes and TENDON RUPTURE

Ex: Ciprofloxacin (Cipro), Levofloxacin (Levaquin)

Topical Antifungal

Ringworm, athletes foot, jock itch, thrush

SE: stinging/redness

Ex: Clotrimazole, Nystatin

Antimalarial agent

RA, Lupus, Malaria

SE: GI upset, vision changes, seizures

Ex: Hydroxychloroquine (Plaquenil)

Systemic Antivirals

Herpes, Influenza A/B

SE: GI upset, nephrotoxicity

Administer within 48 hrs of onset of symptoms

Ex: Acyclovir, oseltamivir (Tamiflu)