Pharmacology Exam 2 Medications

Aspirin

Non-narcotic analgesic, antipyretic, antiplatelet

Aspirin Therapeutic Effects and Uses

Mild to moderate pain, inflammation, fever

Aspirin Mechanism of Action

Reduces prostaglandin synthesis

Aspirin Distribution

Crosses placenta; 80-90% protein bound

Aspirin Common Adverse Effects

Stomach irritation, heartburn, nausea, vomiting, diarrhea, stomach pain

Aspirin Serious Adverse Effects

Bronchospasm, laryngeal edema, anaphylaxis, hypersensitivity reaction

Aspirin Hematologic Effects

Thrombocytopenia, hemolytic anemia, occult bleeding

Aspirin Rare Toxicities

Nephrotoxicity, hepatotoxicity

Aspirin Unique Effects

Tinnitus, hearing loss (high doses)

Aspirin Contraindications

Aspirin triad (asthma, nasal polyps, chronic rhinitis/bronchospasm), history of GI bleed

Aspirin Pediatric Risk

Children/teens with flu or fever → Reye's syndrome

Aspirin Age Consideration

Avoid in patients over 60

Aspirin Drug Interactions

Other salicylates → increased toxicity; Acetaminophen → kidney toxicity; Alcohol (3+ drinks/day) → GI ulcers; Corticosteroids → gastric irritation, GI ulcers

Aspirin Herbal Interactions

Caffeine (↑ absorption), St. John's Wort (↑ sedation)

Aspirin Overdose Management

Emesis, gastric lavage, hemodialysis

Ibuprofen

Analgesic, antipyretic, anti

Ibuprofen Therapeutic Effects and Uses

Mild to moderate pain, fever, RA, OA, myalgia, headache, dental pain, dysmenorrhea

Ibuprofen Mechanism of Action

Reduces prostaglandin synthesis

Ibuprofen Distribution

Crosses placenta, highly protein bound

Ibuprofen Common Adverse Effects

GI bleeding, anorexia, heartburn, nausea, vomiting, diarrhea, constipation; dizziness, headache, drowsiness

Ibuprofen Serious Adverse Effects

Peripheral edema

Ibuprofen Black Box

Fatal CV thrombotic events, GI adverse effects

Ibuprofen Contraindications

Allergy, PUD, bleeding abnormalities, CABG perioperative pain

Ibuprofen Precautions

HTN, HF, GI bleed hx, stroke, MI, DM, renal/hepatic impairment, asthma in pediatrics

Ibuprofen Drug Interactions

↑ toxicity with digoxin, lithium, methotrexate

Ibuprofen Herbal Interactions

↑ bleeding with feverfew, garlic, ginger, ginkgo

Ibuprofen Overdose Management

Activated charcoal, NG suction

Celecoxib (Celebrex)

Anti-inflammatory

Celecoxib Pharmacologic Classification

COX-2 selective NSAID

Celecoxib Therapeutic Effects and Uses

Mild to moderate pain, inflammation

Celecoxib Mechanism of Action

Selective COX-2 inhibitor → ↓ prostaglandin synthesis

Celecoxib Distribution

97% protein bound

Celecoxib Common Adverse Effects

GI upset, dyspepsia, URI, cough, severe skin reactions

Celecoxib Black Box

Fatal CV events, GI bleeding

Celecoxib Contraindications

Hepatic impairment, CKD, anemia, CABG postop, GI bleed hx

Celecoxib Precautions

Anticoagulants, asthma hx, bone marrow suppression, stroke, PVD, HF, fluid retention

Celecoxib Drug Interactions

↑ lithium toxicity; ↓ antihypertensive effects

Celecoxib Herbal Interactions

↑ bleeding

Celecoxib Overdose Management

Activated charcoal, NG suction

Acetaminophen

Non-opioid analgesic, antipyretic

Acetaminophen pharmacologic class

Non-opioid analgesic, antipyretic- Para-aminophenol derivative

Acetaminophen Therapeutic Effects and Uses

Mild to moderate pain

Acetaminophen Mechanism of Action

Inhibits pain mediators, acts on hypothalamus for fever

Acetaminophen Distribution

Crosses placenta; 25% protein bound

Acetaminophen Common Adverse Effects

Hepatotoxicity, ↑ ALT/AST, ↑ bilirubin

Acetaminophen Serious Adverse Effects

Neutropenia, pancytopenia, leukopenia, thrombocytopenic purpura, hepatotoxicity in alcoholics or CKD

Acetaminophen Black Box

Severe liver injury, anaphylaxis

Acetaminophen Contraindications

Severe hepatic/renal impairment

Acetaminophen Precautions

Anemia, bone marrow depression, immunosuppression

Acetaminophen Drug Interactions

↑ hepatotoxicity with alcohol; ↑ bone marrow toxicity with antiretrovirals

Acetaminophen Herbal Interactions

Caffeine ↑ analgesic effects

Acetaminophen Overdose Management

Acetylcysteine (3-bag IV protocol)

Methotrexate (DMARD Prototype)

Antirheumatic, immunosuppressant

Methotrexate Therapeutic Classification

Antirheumatic, immunosuppressant

Methotrexate Pharmacologic Classification

Antimetabolite (folate antagonist)

Methotrexate Nursing Considerations

Avoid alcohol; Use contraception during and after therapy

Adalimumab (Biologic DMARD Prototype)

Antirheumatic, anti-inflammatory

Adalimumab Indications

Moderate to severe RA (alone or with methotrexate)

Adalimumab Black Box Warning

Risk of serious infections and malignancies

Prednisone (Corticosteroid Prototype)

Antirheumatic, anti-inflammatory

Prednisone Monitoring

Baseline and ongoing labs; bone protection (Ca/Vit D, bisphosphonate within 3 months); PPI if GI risk + NSAID; PJP prophylaxis if high dose ≥20 mg/day + immunosuppressant

Prednisone Tapering/Adrenal Suppression

Suppression risk if ≥3 weeks; taper gradually; stress

Prednisone Patient Education

Take in morning; Never stop abruptly; Report fever, sore throat, black

Hydroxychloroquine

Antimalarial Prototype.

HydroxychloroquineTherapeutic Classification

Antirheumatic

Hydroxychloroquine Pharmacologic Classification

Antimalarial

Hydroxychloroquine Indications

SLE (reduces flares)

Hydroxychloroquine Mechanism of Action

Inhibits antigen processing and immune cell activation;

Hydroxychloroquine Common Adverse Effects

GI upset, skin rash;

Hydroxychloroquine Serious Adverse Effects

Retinal damage (irreversible);

Hydroxychloroquine Contraindications

Relative contraindication in pregnancy;

Hydroxychloroquine Drug Interactions

Antacids ↓ absorption;

Hydroxychloroquine Nursing Considerations

Take with food or milk; Annual eye exams; Report blurred vision immediately.

Colchicine

Antigout Prototype;

Colchicine Therapeutic Classification

Antigout;

Colchicine Pharmacologic Classification

Microtubule assembly inhibitor;

Colchicine Indications

Acute gout flares;

Colchicine Mechanism of Action

Inhibits microtubule formation → ↓ leukocyte migration;

Colchicine Common Adverse Effects

GI upset; malnutrition and electrolyte abnormalities with prolonged use;

Colchicine Serious Adverse Effects

Myelosuppression, cytopenias, myopathy;

Colchicine Contraindications

Severe renal/hepatic disease; caution in pregnancy;

Colchicine Drug Interactions

CYP3A4 inhibitors ↑ toxicity; statins ↑ myopathy risk;

Colchicine Nursing Considerations

Start within 24

Allopurinol

Xanthine Oxidase Inhibitor Prototype;

Allopurinol Therapeutic Classification

Antihyperuricemic;

Allopurinol Pharmacologic Classification

Xanthine oxidase inhibitor;

Allopurinol Indications

Chronic gout prophylaxis; prevention of tumor lysis syndrome;

Allopurinol Mechanism of Action

Inhibits xanthine oxidase → ↓ uric acid formation;

Allopurinol Common Adverse Effects

Hepatotoxicity, bone marrow suppression;

Allopurinol Serious Adverse Effects

Rash (SJS/TEN risk);

Allopurinol Contraindications

Hypersensitivity; caution in pregnancy;

Allopurinol Drug Interactions

Warfarin (↑ bleeding risk); azathioprine (↑ toxicity);

Allopurinol Nursing Considerations

Stop immediately if rash develops; Monitor LFTs; Take after meals (never on empty stomach).

Probenecid

Uricosuric Prototype;

Probenecid Therapeutic Classification

Uricosuric;

Probenecid Pharmacologic Classification

Uric acid reabsorption inhibitor;

Probenecid Indications

Chronic gout;

Probenecid Mechanism of Action

Blocks uric acid reabsorption in renal tubules;

Probenecid Common Adverse Effects

GI upset, kidney stones;

Probenecid Serious Adverse Effects

None noted;