Pharmacology FInal Chapter 8

most common oral fungus

Candida albicans

acute pseudomembranous candidiasis (thrush)

-The tongueshows a superficial layer of a loose, cream-colored deposit

•Raised curdlikepatchesare present

-These patches can be removed, revealing an erythematous baseunderneath

atrophic (erythematous) candidiasis

-Intensely erythematous and atrophic mucosaunder a maxillary denture

•The mucosa is highly sensitiveand periodically painful

•Smooth, beefy-red, sensitive tonguedue to loss of papillae(resulting from long-term persistent candidiasis)

•Mild form of Candida albicans-induced angular cheilitis(also known as perlèche)

thrush

is a medical condition in which a yeast-like fungus called Candida albicans overgrows in the mouth and throat.

It is part of the normal flora; overgrows if patient is on long term antibioticsor ill-fitting denture

antifungal agent that hs poor oral absorption. Poorly absorbed from the GI tract

nystatin

nystatin is used for?

treat and prevent candidiasis

Nystatin: Pastilles (Iozenges) takes how long to be absorbed in the mouth?

15 minutes

How long should you use nystatin

for 10-14 days depending on severity

•Or 48 hrs after signs and symptoms are eradicated (gone)

adverse reaction to Imidazole- Clotrimazole

Most common GI: abdominal pain, diarrhea and nausea

•

NOT RECOMMENDED for pregnant and children under 3yrs

Uses for Imidazole-clotrimazole

•

Treatment of OROPHARYNGEAL candidiasis (oral thrush)

•

Treatment of denture stomatitis

Imidazole-clotrimazole (Lozenge/ tablet) adult dosage

Adult dosage: 1 lozenge (10mg) 5 times/daily for 10-14 days (or longer for immunosuppressed)

how much glucose is in each lozenge (tablet for imidazole-clotrimazole)

0.9 g

dental considerations for taking Imidazole-clotrimazole

clients with xerestomia may have difficulty

imidazole-ketoconazole adverse reactions

•

Nausea and vomiting (3-10%), to prevent TAKE WITH FOOD!

•

Hepatoxicity, idiosyncratic reaction can be fatal.

•

Many drug interactions; interfere with WARFARIN increase blood level high risk for bleeding.

Uses for imidazole-ketoconazole

ONLY if all other antifungals are ineffective!

•

Treatment of mucocutaneousand oropharyngeal candidiasis (oral thrush)

•

Prophylactically in chronic mucocutaneous candidiasis

imidazole- ketoconazole DH considerations

TO BE USED only if other antifungal agents are ineffective!!

•

interfere with WARFARINincrease blood level high risk for bleeding

imidazole- fluconazole is treatments for

Oropharyngeal and esophagealcandidiasis

Prophylactically for candidiasis in the immunocompromised

•Used only if candidal infections that do not respond to other agents

what are antiviral agents for herpes simplex

acyclovir

docosanol10%

penciclovir

famciclovir and valacyclovir

Acyclovir

Inhibits replication of DNA

•

Absorption not effected with food

DO NOT use this as prophylactic(to prevent minor out breaks) since it may lead to resistant strains of herpes)

adverse reactions of acylovir

Orally: HEADACHE, ANOREXIA and “funnytaste”. lymphadenopathy,

Topical Acyclovir is not effective in treating herpes labialis infections in ….

nonimmunocompromised

does acyclovir prevent transmission of infection or reoccurnce?

NO

Oral Acyclovir dosage in immunocompromise

200mg 5x’s daily (q4h) for 5days and 400mg every 5x’s (q4h) daily for 5 days

antiviral agents/ cocktails to manage AIDS

1.

nucleoside reverse transcriptase inhibitors (NRTIs)zidovudine

2.

nonnucleoside reverse transcriptase inhibitors (NNRTIs) nevirapine

3.

protease inhibitorssaquinavir

adverse reactions of NRTI -Nucleoside Reverse Transcriptase Inhibitors

bone marrow depression

altered taste, tongue edema, bleeding gums, mouth ulcers

drug interactions of NRTI

Acetaminophen. Cause higher inceidence of granulocytopenia

HIV 1 is transmitted by

sex, body fluids, IV substance abuse, during pregnancy and childbirth

HIV 2 is transmitted by

from a women to her child while the child is in the womb.

Protease Inhibitors (PI)

Prevent the maturation of HIV infected cells

•Difference is that unlike NRT and NNRT, this can interfere with the action of HIV-infected cells

Protease Inhibitors (PI) adverse reactions avoidance

• avoid sunlight

• take 2 hours before a meal

fusion/entry inhibitors do

halt progression of HIV to AIDS

Postexposure Therapy (PEP)

To begin within 72 hours of exposure to the virus usually via needle or instrument stick.

Truvada (tenofovir and emtricitabine) plus raltegravir(Isenttress; RAL) 400mg PO bid OR dolutegravir (Tivicay) 50mg PO daily for 28 days

most common cause of chronic hepatits

Hep B and C

which hepatitis is more at risk for chronic hepatitis

Hep C

flu is a ___ onset

sudden

cold is a ____ onset

gradual

covid 19 is a ___ onset

gradual or sudden

Polymerase acidic endononuclease inhibitor is a treatment for flue for those older than ..

12

Monoclonal Antibodies

FDA Emergency Use Authorization for mild-moderate COVID-19

•

For high-risk individuals (e.g., immunocompromised or unvaccinated)

•

Administered intravenously (REGEN-COV also subcutaneously)

•

Monitor for 1 hour after infusion for reactions

Penciclovir

over acyclovir it can achieve higher concentration in the cell and remains longer

Famciclovir and Valacyclovir

• treats recurrent genital herpes

• treat acute varicella-zoster

• prodrug converted to penciclovir and acyclovir

examplle of an NNRTI

Nevirapine.