Meds

PO route

by mouth

most common

aka ‘enteral’

systemic effect

sublingual route

under tongue

absorbs into bloodstream via capillaries

systemic effect

intranasal route

into nasal cavity

capillary absorption

local or systemic effect

inhalation route

breathed into lungs

rapid effects

localized or systemic effect

endotracheal route

ER/ICU situation

topical route

applied directly to surface

local effect

minimal systemic presence

transdermal route

dermal capillary absorption

systemic effect desired

long acting

rectal route

inserted into the lower GI, rectum

local and systemic effect

low 1st pass metabolism

IV route

needle-catheter into a vein

immediate absorption

systemic effect

IM route

needle injection into muscle tissue

capillary bed absorption into bloodstream

system effect

subcutaneous route

injection into adipose tissue of hypodermis

absorption via capillary bed

systemic effect

drugs that are extensively bound

warfarin

ibuprofen, naproxen (NSAIDS)

furosemide

Digitoxin

ASA overdose s&s

confusion

tachycardia

tachypnea

hyperthermia

diaphoresis

vomiting

Acetaminophen overdose s&s

abdominal pain

loss of appetite

nausea/vomiting

diaphoresis

somnolence

Opioid overdose s&s

bradypnea/apnea

bradycardia

somnolence/coma

pupils constricted

Cocaine overdose s&s

agitation, tremors

tachycardia

tachypnea

hyperthermia

diaphoresis

pupils dilated

tx for pain <4/10

non-opioids: NSAIDS, tylenol

tx for pain 4-6/10

opioids: codeine, combination, morphine

tx for pain >6/10

higher potency opioids

consider PCA

Acetaminophen

aka tylenol

centrally acting analgesic

antipyretic - highest efficacy

acetaminopheni administration

PO q4h

opioids (morphine-like)

centrally acting analgesics

agonists: mu, kappa delta receptors

inhibit release of sub. P

high-efficacy opioids

fentanyl, hydromorphone (dilaudid)

meperidine (demerol), morphine

methadone (metadol)

moderate efficacy opioids

hydrocodone. oxycodone (Oxyneo), oxycontin, tramadol (Ultram)

Combo drugs

percocet

percodan

vicodin

tramacet

OD tx of opioids

Naloxone

onset of naloxone

2-4 mins

duration of action for naloxone

45 min

how do you treat opioid dependence

methadone

anti-inflammatory drugs MOA: for injury

release chemical signals - potassium ions, bradykinins, pyrogens

anti-inflammatory drugs MOA: cellular injury

inhibit prostaglandin formation via cox enzyme inhibition

modulate pain and fever as well

Describe celecoxib

black box CV warning

rx only

selective for cox-2

Why dont we give aspirin to kids

can cause reye’s syndrome

kinetics of glucocorticoids

endogenous hormone

adrenal cortex secretion

lipophillic

nuclear receptor binding

Effects of glucocorticoids

fasting: gluconeogenesis, protein degradation, lipolysis

COX-2 inhibition (prostoglandin synthesis)

phagocytes/lymphocyte syppression

suppresion of histamine

glucocorticoid dynamics

very potent

high efficacy for severe/acute cases

glucocorticoid medications

hydrocortisone, cortisone, prednisone, prednisolone, methylprednisolone, dexamethasone

Systemic inflammation uses for glucocorticoids

autoimmune: IBD, lupus

drug: dexamethasone

anaphylaxis

local use of glucocorticoids

joints

intranasally: budenoside, fluticasone, mometasone

inhalation use of gluticorticoids

asthma

pulmicort, Qvar, flovent

prevention of asthma

glucocorticoids

leukotriene modifiers

mast cell stabilizers

control of irritants

rescue tx of asthma: bronchodilators

B2 adrenergic agonisits

* salbutamol (ventolin, albuterol)

rescue tx of asthma: anticholinergics

inhibits PNS

atrovent

rescue tx of asthma: epinephrine

short onset

short t 1/2

1st gen antihistamine dynamics

blocks histamine receptors

crosses BBB = CNS effects

1st gen antihistamine meds

diphenhydramine (benadryl, allerdryl)

chlorpherinamine (benylin)

2nd gen antihistamine dynamics

block H1 histamine receptors

decreased CNS distribution - non-drowsy

2nd gen antihistamine meds

fexofenadine (allegra)

loratadine (claritin)

cetirizine (reactin)

desloratadine (Aerius)

onset and duration of cetirizine (reactin)

onset - 10-20 min

duration - 24hrs

med for known allergy present:

antihistamines, non drowsy preferred

1 tablet qd

eye symptoms during allergy protocol

olopatadine (patanol) eye drops

higher allergen exposure levels anticipated

leukotriene modifiers

* 1 tablet singulair x 2 days pre-exposure

anti-tussive dynamics

CNS depression of cough reflux

\*not always desirable

Anti-tussive meds

codeine - dextromethorphan (direct CNS acting)

tx of congestion

sympathomimetics (Adrenergic agonists)

SNS stimulation = decreased nasal secretions

sympathomimetic meds

ephedrine

pseudoephedrine

what drug classes inhibit cell wall synthesis

penicillins

cephalosporins

bacitracin

vancomycin

what drug class inhibits protein synthesis

chloramaphenicol

erythromycin

tetracyclines

streptomycin

what drug classes inhibit replication of nucleic acid and transcription

quinolones

rifampin

what drug classes inhibit synthesis of essential metabolites

sulfanilamide

trimethoprim

beta-lactam abx

penicillins

cephalosporins

carbapenems

penicillin dynamincs

efficacy: g+ and g-

narrow broad spectrum

penicillin tx: pharyngitis

bacteria = s. pyogenes (g+)

med: penicillin V, PO

Penicillin tx: ottitis media

bacteria = s. pneumonae, Hib, Moraxella

med: amoxicillin PO

Cephalosporins

1st choice for skin infections

gen 3-5 cross BBB

resistant bacterial infections like MRSA

1st gen cephalosporin meds

cefazolin(Ancef), IV

Cephalexin (keflex), PO

Cefurozime

Cephalosporin gens 3-5 meds

Ceftriaxone

Ceftazidime

Ceftaroline

cephalosporin gen 3-5 efficacy

bacterial meningitis

Carbapenem dynamics

potent

efficacy: broad spectrum, serious and mixed infections (meningitis, aspiration pneumonia)

Bacitracin efficacy

gram +

bsa

topical, opthalmic, ear preparations

bacitracin can tx what

conjunctivitis

skin/soft tissue topical infections

prophylactic

what is the other name for bacitracin

polysporin

vancomycin is what drug class

glycopeptide abx

what is 1st and 2nd choice of tx with vancomycine

1st - MRSA

2nd - c. diff

abx of choice for c diff

flagyl (1st)

vancomycin (2nd)

efficacy of macrolides

1st: community acquired adult pneumonia

tx option for gonorrhea comvined w a cephalosporing

macrolide meds

erythromycin

azithromycin (zithromax)

clarithromycin (biaxin)

efficacy of tetracyclines

gram - and +

tetracycline meds

tetracycline

doxycycline

monocycline

s/e of tetracycline

bone deformation

aminoglycoside meds

gentamicin

streptomycin

neomycin

tobramycin

describe aminoglycosides

potent

Narrow TI

efficacy of aminoglycosides

higher risk infections

tobramycin eye drops - bacterial conjunctivitis

s/e of aminoglycosides

cytotoxic

lincosamide meds

clindamycin

efficacy of lincosamides

surgical prophylaxis

fluoroquinolone meds

ciprofloxacin, levofloxacin, norfloxacin

efficacy of fluoroquinolines

gram -

GI infections

UTI

nitromidazole meds

metronidazole (flagyl)

efficacy of nitroimidazoles

c. diff

h. pylori

prophylaxis (Dental

sulfonamide meds

sulfamethoxazole, t-sulfamethoxazole (TMP/SMX, Bactrim, Septra)

efficacy for sulfonamides

UTI

General side effects of abx

GI - diarrhea, abd pain, nausea

Superinfection

Drug-drug

Allergy

Polyene fungal abx meds

amphotericin B

nystatin

efficacy of polyene fungal abx

increase CM permeability

efficacy of amphotericin B

1st choice therapy fungal infections

What does nystatin treat

candida (skin, GI)

* PO

TB tx

rifampin - DNA inhibition

isoniazid - cell wall synthesis inhibition

HIV tx

PEP - 3x for 28 days

What does acyclovir treat

Herpes simplex 2