knowt copy of zohas notes (pharm final)

not my info or workkk

Antacids
A.C.I.D.
A -> (acid neutralized)
C -> (constipation and diarrhea)
I -> (indigestion relief)
D -> (decrease absorption)

Mechanism of Action: neutralize gastric acid (↑ stomach pH) and enhance gastric mucosal defence

Indications:
-PUD
-Gastritis
-GERD/Acid Reflux
-Dyspepsia (heartburn)

Contraindications:
-KDA
-Severe renal failure
-Electrolyte imbalance
-GI obstruction

Adverse Effects:
-Diarrhea (from Magnesium)
-Constipation (Calcium/Aluminum)
-Kidney stones
-Long-term use can mask serious conditions

Interactions:
-↓ absorption of many drugs
-↑ gastric pH alters drug activity
-premature breakdown of EC medicatio

H2 Receptor Antagonists
H.H.H.H
H -> Halt H+ secretion
H -> head confusion
H -> hepatic enzyme inhibited
H -> higher drug levels

Mechanism of Action: blocks H2 receptors on parietal cells; decreases gastric acid/H+ secretion

Indications:
-GERD
-PUD
-Erosive esophagitis
-Prevent aspiration pneumonia

Contraindications:
-KDA
-Liver/kidney dysfunction

Adverse Effects:
-CNS: confusion, disorientation
-Endocrine: gynecomastia, ED

Interactions:
-inhibit liver enzymes = ↑ drug levels
-↓ absorption of drugs
-Smoking decreased effectiveness

Protein Pump Inhibitors
(Permanents Inhibitor + Problematic Long-Term)
Mechanism of Action: complete blockage of H+ secretion

Indications:

-first line for erosive esophagitis
-GERD
-H. Pylori (with antibiotics)

Contraindications: KDA

Adverse Effects:
Long-term use -->
-Osteoporosis
-C. Diff infections
-Gastric Tumour risk

Interactions:
-bleeding risk (w/ anticoagulants)

Sucralfate (Sulcrate)

Binds to ulcers/erosions to form a protective barrier from stomach acid; used for stress ulcers and PUD

Misoprostol

Enhance mucus production to protect the gastric mucosa from injury; prevents NSAID-induced gatsric ulcers

Antidiarrheals

Indications: treatment of diarrhea

Contraindications:
-KDA
-Major GI condition

Types of Antidiarrheals:

1. Adsorbents

2. Anticholinergics

3. Opiates

4. Probiotics

Adsorbents

Mechanism of Action: coats the wall of the GI tract and binds to the causative agent; eliminated via stool

Adverse Effects:
-Increased bleeding time
-Constipation
-Dark stools
-Black tongue
-Cause Reye's Syndrome in children

Interactions:
-decrease drug absorption

Anticholinergics

Mechanism of Action: slows peristalsis and has a drying effect (reduces gastric secretions)

Adverse Effects:
-Urinary retention
-Headache/dizziness
-Hypotension
-Dry skin

Interactions:
-therapeutic effect decreased when taken with antacids

Opiates

Mechanism of Action: decreased bowel motility, reduced pain by relief of rectal spasms, reduces stool frequency/volume

Adverse Effects -> drowsiness, dizziness, constipation, hypotension, respiratory depression

Interactions -> CNS depressant effect if given w/ alcohol, opioids, or antipsychotics

Probiotics

Mechanism of Action: replenish bacteria and restore the normal flora destroyed by diarrhea-causing bacteria

Laxatives

Indications -> facilitate bowel movements for constipation, pregnancy, prep for colon procedures/surgeries, etc.

Contraindications -> KDA, Appendicitis, intestinal obstruction, and undiagnosed abdominal pain

Interactions -> alter the intestinal function, react with food

Bulk-Forming

Mechanism of Action: high in fibre and absorbs water; distends the bowel to initiate reflex bowel activity

Indication -> acute/chronic constipation, IBS, diverticulosis

Emollient

Mechanism of Action: stool softener; lowers surface tensions and absorbs water/fat in stool

Indications -> acute/chronic constipation, fecal impaction

Hyperosmotic

Mechanism of Action: increase fecal water content

Indication -> chronic constipation, bowel prep and lactulose

Saline

Mechanism of Action: increases osmotic pressure in the small intestine (inhibits water absorption of the small intestine)

Indication -> constipation and bowel preparation

Stimulants

Mechanisms of Action: stimulate peristalsis

Indication -> acute constipation and bowel prep

Anticholinergic (ACh Blockers)

Indications -> motion sickness, nausea and vomiting

Adverse Effects:

• dizziness, drowsiness, disorientation
  -tachycardia
  -blurred vision, dilated pupils
  -rash, erythema

Antihistamine Drugs (H1 Receptor Blockers)

Indications -> motion sickness, rhinitis, allergy symptoms, nausea and vomiting

Adverse Effects:
-dizziness, drowsiness, confusion
-blurred vision, dilated pupils, dry mouth
-urinary retention

Antidopaminergics

Indications -> psychotic disorders, nausea and vomiting

Adverse Effects:
-Orthostatic hypotension, tachycardia
-blurred vision, dry eyes
-dry mouth, anorexia, constipation
-urinary retention

Prokinetic Drugs

indications -> delayed gastric emptying, GERD, nausea and vomiting

Adverse Effects:
-hypotension
-sedation, fatigue, restlessness, headache
-dry mouth, nausea and vomiting, diarrhea

Serotonin Blockers

Indications -> nausea and vomiting (associated with chemotherapy)

Adverse Effects:
-headache, diarrhea
-rash, bronchospasm

Tetrahydrocannabinol

Indication -> nausea and vomiting, anorexia

Adverse Effects:
-drowsiness, dizziness
-anxiety, confusion, euphoria
-dry mouth

Diclectin (doxylamine/pyridoxine)

Indications -> nausea and vomiting during pregnancy (nighttime dose is effective in the morning)

Dose:
-2 @ bedtime
-1 @ morning
-1 @ mid-afternoon

Sulfonamides

MOA: bacteriostatic; inihibts bacteria growth by preventing folic acid production

Indications -> res[iratory tract infections, prophylaxis, pneumonia

Contraindications:
-KDA
-Chemically related drugs
-pregnancy at term/nursing
-children <2 months

Adverse Effects:
-agranulocytosisi
-nausea, vomiting, diarrhea
-convulsions

Becta-Lactam Antibiotics

1. Penicillin -> bactericidal

2. Cephalosporins -> bactericidal; interfere with cell wall

3. Carbapenems -> bactericidal; broad antibacterial action

4. Monobactams

Penicillin

Mechanism of action: slide through bacterial cell walls and cause bacterial death via lysis

Indications:

• Treatment of infections caused by bacteria

• Pneumonia, intra-abdominal infections, sepsis

Contraindications: allergies

Adverse effects: lethargy, nausea, diarrhea, hyperkalemia, hives/rash

Interactions: aminoglycosides, NSAIDs, oral contraceptives

Cephalosporins

Adverse effects:

-Diarrhea, abdominal cramps
-Rash
-Cross-sensitivity with penicillin if allergies exist

**most cephalosporins start with cef-, ceph-, or kef- (ex. cefazolin, cefuroxime, etc.

Carbapenems

Acutely ill-complicated body cavity and connective tissue

• May cause drug-induced seizure
  **examples: imipenem, meropenem, ertapenem

Macrolides

Erythromycin, Clarithromycin, Azithromycin

MOA: bacteriostatic (bactericidal to some bacteria); effective treatment of a wide range of infections

Indications:
-"Strep" infections
-Mild to moderate upper/lower respiratory infection
-Gonorrhea/Chlamydia
-Mycoplasma

Adverse effects:
-Palpitations, chest pain, QT prolongation
-Headache, dizziness
-Nausea, hepatotoxicity
-Hearing loss, tinnitus

Interactions: highly protein-bound and are metabolized in the liver; reduce the efficacy of oral contraceptives

Tetracyclines

Bacteriostatic -> inhibits bacterial protein synthesis

MOA: inhibits growth and kills a wide range of Rickettsia, Chlamydia, and Mycoplasma organisms

Indications: complicated infection, intra-abdominal infection, community-acquired pneumonia

Contraindications: KDA, avoided by pregnant and nursing women

Adverse effects:
-Discoloration of teeth in fetuses and children
-Photosensitivity
-Diarrhea

Interactions:
-If taken with antacids, antidiarrheal drugs, dairy, calcium, or iron = absorption reduces
-Increase blood urea nitrogen (BUN)
-Potential effects on oral anticoagulants

Aminoglycosides

Bactericidal (prevents protein synthesis) and has poor oral absorption

Types of Aminoglycosides:

1. Gentamicin

2. Tobramycin

3. Amikacin

Indications:
-Gram-negative bacteria
-Often used with other antibiotics; synergistic effects
-Gram-positive infections resistant to other antibiotics

Contraindications:
-KDA
-Pregnancy (crosses placenta and causes fetal harm; deafness)/ pass in breast milk
-Caution in neonates; immaturities of newborn kidneys put them at risk for toxicity

Adverse Effects:
-Nephrotoxicity; reversible
-Ototoxicity; not reversible
-Headache, vertigo, skin rash, overgrowth of non-susceptible organisms, neuromuscular paralysis

Interaction:

1. Use caution with other nephrotoxic drugs

2. Using loop diuretics may increase the risk of ototoxicity

3. Kill normal flora that produce Vitamin K

4. Increased bleeding time with warfarin

Quinolones

MOA: Bactericidal and DNA production (does not affect human DNA)

Indications:
-Gram-negative and gram-positive bacteria; complicated urinary tract, respiratory, GI, and skin infections
-Ciprofloxacin and levofloxacin both oral and injection
-Norfloxacin hydrochloride has limited oral absorption; only in oral from

Interactions:
-Decreased absorption of antibiotics
-Oral anticoagulants
-At least 1-2 hours before or after

Adverse Effects:
-QT prolongation
-Label warning: increased risk of tendonitis
-Label warning: worsening of muscle weakness and breathing difficulties
-Seizures have been reported
-Slow infusion; reduces venous irritation

Clindamycin (Dalacin C)

® Semisynthetic

® Bactericidal OR bacteriostatic; inhibits protein synthesis
® Negative/positive and anaerobic bacteria
® Chronic bone, genitourinary, and intra-abdominal infection
® C. difficile
® Neuromuscular blocking properties; may enhance neuromuscular drugs

Linezolid (Zyvoxam)

Works by inhibiting protein synthesis and has excellent oral absorption

Indications:
-VRE bacteria
-Pneumonia; complicated skin infection (ex. MRSA)
-Gram-positive; infants and children

Adverse Effects:
-headache, nausea, diarrhea, vomiting
-Decrease platelet count

Interactions:
-Strengthens effects of vasopressive drugs (prohypertensive)
-Antidepressants
-Tyramine-containing foods

Metronidazole (Flagyl)

Works by interfering with microbial DNA synthesis

(NOT RECOMMENDED: first trimester of pregnancy)

Adverse Effects:
-Dizziness, headache, GI discomfort, nasal congestion,

Interactions:
-Avoid alcohol for 24 hours before and 36 hours after the last dose
-Increase the toxicity of many drugs
-Phenytoin and Phenobarbital à reduce the effects of metronidazole

Nitrofurantoin (MacroBID)

Works by disrupting bacterial cell wall formation

Primarily used for UTIs

Adverse Effects:
-GI discomfort, dizziness, headache, skin reactions
-Possible irreversible peripheral neuropathy and hepatotoxicity

Interactions:
-Probenecid: reduced kidney excretion
-Antacid: reduce GI absorption
-Decrease dose for older patients and those with decreased renal functions

Vancomycin hydrochloride (Vanocin)

Bacterial antibiotic; cell wall synthesis

Indications:
-Gram-positive MRSA infection
-Oral vancomycin; C. difficile

Adverse Effects:
-Ototoxicity and nephrotoxicity
-Red Man Syndrome: flushing, itching of head/face/neck; caused by rapid infusion (infuse over 60 minutes)
-Rapid infusion may cause hypotension, muscle spasm, and dyspnea

Imidazole and Triazoles

® Effective for topical/cutaneous infection

® Inhibit fungal cell cytochrome P450 enzymes resulting in cell membrane leaking
® Result: altered cellular metabolism and fungal cell death

Echinocandins

® Treatment of systemic infections

® Prevent synthesis of glucans (essential part of fungal cell wall)
® Result: fungal cell death

Polyenes

® Bind to sterols in cell membrane lining

® Result: fungal cell death
® Do not bind to human cell membranes or kill human cell; safe for us

Amphotericin B

(severe fungal infections)

Adverse Effects:
"Shake and Bake Syndrome"
® Cardiac dysrhythmia
® Neurotoxicity (trinities, visual disturbance, convulsions)
® Kidney toxicity
® Pulmonary infiltrates
® Fever, chills, headache, nausea

Prevention of adverse effects:
® Commonly order premedication (ex. antiemetics, antihistamines, antipyretics, etc.); use IV infusion pumps and most distal veins
® Prevention or minimize infusion-related reaction to amphotericin B
® Use longer-than-average drug infusion times

Antihistamines

2 Types:

1. First Generation: dimenhydrinate (Gravol), diphenhydramine (Benadryl), promethazine

2. Second Generation: Loratadine (Claritin), cetirizine (Reactine), and fexofenadine (Allegra)
   ® Longer duration of action; increase compliance with once-daily dosing
   MOA: blocks the action of histamine at H1 receptor sites

Indications: allergic rhinitis, common cold symptoms, allergic reaction, insomnia, vertigo

Contraindications: KDA, acute-angle glaucoma, cardiac disease/HTN, Bronchial asthma/COPD

Adverse Effects: anticholinergic effects (dry mouth, difficulty urinating, constipation), drowsiness, hypertension

Nursing Implications: drowsiness (warn driving, allergy, some anticholinergic effects)

Decongestants

hree groups:

1. Adrenergic (Sympathomimetics) *largest group)

2. Anticholinergics (Parasympatholytic) à less commonly used

3. Corticosteroids (topical or intranasal)
   Indication: nasal congestion

Adverse Effects:
® Oral: insomnia, palpitations
® Nasal: mucosa irritation
® Rebound congestion (adrenergic)

Nursing Implications:
® Nasal application
® Warn rebound edema/congestion

Antiussives

Common Types/Examples:

1. Codeine-Opioid: CNS depression (suppresses the cough center in the medulla and has a drying effect in the CNS)

2. Dextromethorphan: non opioid; CNS cough center

Adverse Effects:
Codeine -> CNS depression, alcohol/sedatives, constipation, controlled substance, drug allergy
Dextromethorphan -> don't use if: hyperthyroidism, HTN, unstable heart disease

Nursing Implications:
® Report coughs that last more than a week, headache, fever/rash
® Used for the therapeutic effect of a nonproductive cough

Expectorants

Mechanism of Action:

-Reflex stimulation -> irritation of the GI tract; loose/thin -respiratory tract occurs in response to irritation
-Direct stimulation -> secretory glands stimulated directly to increase production of respiratory tract fluids; results in thinner mucus, easier to remove

Indications: relief of productive coughs associated with common cold, bronchitis, pneumonia, and COPD

Nursing Implications:
® Used with caution in older adults and patients with asthma/respiratory insufficiency
® Receive more fluids to loosen secretions
® Report fever, cough, or other symptoms lasting longer than 1 week

Short-Acting Beta₂-Agonists (SABA) - e.g., albuterol

MOA: Stimulate β₂ receptors → bronchodilation (relax airway smooth muscle)

Indications: Acute asthma attacks, rescue inhaler
Adverse Effects: Tachycardia, tremors, jitteriness
Notes: First-line for acute exacerbations

Long-Acting Beta₂-Agonists (LABA) - e.g., salmeterol

MOA: Long-acting β₂ stimulation → sustained bronchodilation

Indications: Maintenance therapy for asthma & COPD
Contraindications/Cautions: Not for acute attacks
Adverse Effects: Palpitations, insomnia, jitteriness
Interactions: Beta-blockers ↓ effect, MAOIs → HTN, ↑ blood glucose
Notes: Often combined with corticosteroids

Short-Acting Muscarinic Antagonists (SAMA) - ipratropium

MOA: Blocks muscarinic receptors → prevents bronchoconstriction

Indications: Asthma, COPD (adjunct)
Adverse Effects: Dry mouth, throat irritation
Notes: Anticholinergic bronchodilator

Long-Acting Muscarinic Antagonists (LAMA) - tiotropium

MOA: Blocks ACh receptors → bronchodilation, ↓ secretions

Indications: Prevention of bronchospasm in COPD
Contraindications: Not for acute symptoms
Adverse Effects: Dry mouth, urinary retention, GI distress, headache

Corticosteroids (Glucocorticoids) - e.g., fluticasone, budesonide

MOA:

Stabilize inflammatory cells
↑ β₂ receptor responsiveness
↓ inflammation
Indications: Asthma, COPD (long-term control)
Adverse Effects: Oral infections, dry mouth, cough, pharyngeal irritation
Interactions: ↑ glucose, ↑ immunosuppressants, hypokalemia risk
Teaching: Rinse mouth after use

Xanthine Derivatives - theophylline

MOA: Inhibits phosphodiesterase → ↑ cAMP → bronchodilation

Indications: Asthma, COPD (adjunct; not acute attacks)
Contraindications: Dysrhythmias, seizures, hyperthyroidism, PUD
Adverse Effects: N/V, tachycardia, dysrhythmias, hyperglycemia
Notes: Narrow therapeutic range, caution in cardiac patients

Leukotriene Receptor Antagonists (LTRA) - montelukast, zafirlukast

MOA: Block leukotrienes → ↓ inflammation, mucus, bronchoconstriction

Indications: Long-term asthma prevention (NOT acute attacks)
Adverse Effects:
Liver dysfunction
Montelukast → suicide risk
Zafirlukast → headache, GI upset

Monoclonal Antibody - Omalizumab

MOA: Binds IgE → prevents allergic mediator release

Indications: Severe allergic asthma
Adverse Effects: Anaphylaxis (serious)
Notes: Given by injection, monitor closely

Combination Inhalers (LABA + corticosteroid) - e.g., Symbicort

MOA: Bronchodilation + anti-inflammatory effect

Indications: Moderate-severe asthma
Notes: Used as maintenance and sometimes as a reliever therap