Comprehensive Pharmacology: NSAIDs, Antibiotics, Vaccines, and Reproductive Drugs

Aspirin (ASA)

Nsaid | Use: reduces pain, inflammation, fever, and prevents arterial thromboembolism | MOA: inhibits prostaglandin synthesis, hypothalamic heat-regulator center, and platelet aggregation | SE: tinnitus, GI distress, thrombocytopenia, leukopenia, bleeding | NC: avoid other NSAIDs or anticoagulants, hold 7 days pre-surgery, take with food/water, monitor for bleeding, avoid in children and 3rd trimester

Ibuprofen

Nsaid | Use: reduce inflammation, pain, and fever | MOA: inhibits COX-1 and COX-2 enzymes to reduce prostaglandin synthesis | SE: GI upset, nephrotoxicity, bleeding | NC: take with food, monitor renal function, avoid alcohol

Celecoxib (Celebrex)

Selective COX-2 inhibitor | Use: treats osteoarthritis, rheumatoid arthritis, and dysmenorrhea | MOA: selectively inhibits COX-2 enzyme to decrease inflammation and pain | SE: edema, headache, GI upset, risk of cardiovascular events | NC: avoid in sulfa allergy and heart disease, monitor edema and pain relief

Allopurinol (Zyloprim)

Antigout | Use: prevent gout attacks by lowering uric acid levels | MOA: inhibits xanthine oxidase to decrease uric acid production | SE: rash, hepatotoxicity, GI upset | NC: increase fluids, monitor liver and renal function, avoid alcohol and purine foods

Prednisone

Corticosteroid | Use: suppress inflammation and immune response | MOA: decreases inflammation by suppressing migration of leukocytes | SE: hyperglycemia, infection risk, mood changes, fluid retention | NC: taper dose, monitor glucose, take with food, avoid abrupt stop

Methotrexate (Rheumatrex)

Antimetabolite/DMARD | Use: rheumatoid arthritis, psoriasis, cancers | MOA: inhibits folic acid metabolism, suppressing DNA synthesis and immune activity | SE: mucosal ulcers, loss of appetite, hepatotoxicity, bone marrow suppression | NC: monitor CBC, liver function, avoid alcohol/pregnancy/NSAIDs, report infection or bleeding

Adalimumab (Humira)

DMARD | Use: rheumatoid arthritis, Crohn's, ulcerative colitis, plaque psoriasis | MOA: inhibits TNF-alpha to reduce joint inflammation and tissue damage | SE: infection, blurred vision, chest pain | NC: monitor for infection, avoid live vaccines, rotate injection sites

Cyclosporine (Gengraf)

Calcineurin inhibitor | Use: prevent organ transplant rejection, autoimmune diseases | MOA: inhibits T-cell activation and proliferation | SE: nephrotoxicity, hypertension, gingival hyperplasia, infection | NC: avoid grapefruit, monitor BUN/Cr, teach infection prevention

Interferon Alfa-2b

Antiviral/antineoplastic | Use: treat hepatitis and certain cancers | MOA: binds to interferon receptors to enhance immune response | SE: chest pain, confusion, blurred vision, injection site reaction | NC: monitor for infection, autoimmune disorders, and mental changes

Cisplatin

Antineoplastic | Use: advanced cancer of bladder, ovaries, testicles | MOA: binds to DNA causing crosslinks and inhibiting replication | SE: ototoxicity, renal toxicity, neuropathy, fatigue | NC: monitor renal and hearing function, CBC, infection signs, hydrate well

Doxorubicin (Adriamycin)

Antitumor antibiotic | Use: treat solid tumors and leukemias | MOA: intercalates into DNA, generates free radicals | SE: bleeding, arrhythmias, myelosuppression | NC: monitor ECG, infection, IV extravasion

Epoetin Alfa (Epogen)

Colony-stimulating factor | Use: treat anemia in chronic renal failure or chemotherapy | MOA: stimulates bone marrow to produce RBCs | SE: hypertension, arthralgia, nausea | NC: monitor Hgb (hold if >11), BP, iron, seizure risk

Filgrastim (Neupogen)

Colony-stimulating factor | Use: prevent neutropenia during chemotherapy | MOA: stimulates production and maturation of neutrophils | SE: bone pain, fatigue, nausea | NC: avoid giving within 24h of chemo, monitor neutrophil count, teach to report infection

Tamoxifen

SERM | Use: treat estrogen receptor-positive breast cancer | MOA: blocks estrogen receptors in breast tissue | SE: hot flashes, DVT risk, endometrial cancer | NC: monitor for clots, use contraception, routine gynecologic exams, no pregnancy

INFECTION: ANTIBIOTICS, ANTIFUNGALS, ANTITUBERCULARS

Amoxicillin (Amoxil)

Penicillin antibiotic | Use: respiratory, ear, urinary, and skin infections | MOA: inhibits bacterial cell wall synthesis | SE: GI upset, rash, superinfection | NC: assess allergy, complete full course, backup birth control, may take with food

Cefazolin (Ancef)

Cephalosporin | Use: surgical prophylaxis, respiratory, urinary, and skin infections | MOA: inhibits bacterial cell wall synthesis | SE: N/V/D, bleeding risk, nephrotoxicity | NC: monitor renal function, avoid alcohol, cross-sensitivity with PCN

Azithromycin (Zithromax)

Macrolide | Use: respiratory, skin, and soft tissue infections in PCN allergy | MOA: inhibits bacterial protein synthesis | SE: N/V/D, hepatotoxicity, ototoxicity | NC: take on empty stomach, avoid antacids, report loose stools

Clindamycin (Cleocin)

Lincosamide | Use: respiratory, skin, bone, and gynecologic infections | MOA: inhibits bacterial protein synthesis | SE: N/V, rash, stomatitis, diarrhea | NC: take with water, monitor for C. diff, avoid alcohol

Vancomycin

Glycopeptide | Use: severe MRSA and resistant infections | MOA: inhibits bacterial cell wall synthesis | SE: red man syndrome, ototoxicity, nephrotoxicity | NC: infuse over 60-90 min, monitor trough, renal, hearing, BP, and IV site

Tetracycline

Tetracycline antibiotic | Use: acne, anthrax, H. pylori, gram +/- infections | MOA: inhibits protein synthesis | SE: photosensitivity, tooth discoloration, hepatotoxicity, GI upset | NC: avoid in pregnancy/children <8, take on empty stomach, avoid dairy/antacids

Gentamicin

Aminoglycoside | Use: serious gram-negative infections | MOA: inhibits bacterial protein synthesis | SE: nephrotoxicity, ototoxicity, superinfection | NC: monitor peak/trough, renal, hearing; avoid mixing with PCNs

Levofloxacin (Levaquin)

Fluoroquinolone | Use: respiratory, skin, and urinary infections | MOA: inhibits bacterial DNA replication | SE: tendon rupture, neuropathy, photosensitivity, dizziness | NC: avoid antacids/NSAIDs, infuse slowly, increase fluids, stop if tendon pain

Trimethoprim/Sulfamethoxazole (Bactrim)

Sulfonamide | Use: urinary, intestinal, respiratory infections, prevent PJP in AIDS | MOA: inhibits folic acid synthesis | SE: rash, crystalluria, blood dyscrasias, photosensitivity | NC: monitor CBC, fluids, avoid sun, take on empty stomach

Isoniazid (INH)

Antitubercular | Use: treat and prevent tuberculosis | MOA: inhibits lipid and DNA synthesis in mycobacteria | SE: peripheral neuropathy, hepatotoxicity | NC: give vitamin B6, monitor liver, avoid alcohol, take on empty stomach

Rifampin (Rifadin)

Antitubercular | Use: active or latent tuberculosis | MOA: inhibits bacterial RNA polymerase | SE: red-orange body fluids, hepatotoxicity, thrombocytopenia | NC: take on empty stomach, monitor liver, use backup contraception

Miconazole (Monistat)

Antifungal | Use: vaginal yeast infections, ringworm, athlete's foot | MOA: disrupts fungal cell membrane by inhibiting ergosterol synthesis | SE: burning, itching, irritation | NC: apply as directed, avoid sex during treatment

ANTIVIRALS & HIV/AIDS-RELATED DRUGS

Acyclovir (Zovirax)

Antiviral | Use: HSV-1, HSV-2, varicella-zoster infections | MOA: inhibits viral DNA synthesis | SE: nephrotoxicity, N/V/D, rash | NC: hydrate, take with food, monitor renal function

Zidovudine (Retrovir)

NRTI | Use: HIV infection, prevention of mother-to-child transmission | MOA: inhibits reverse transcriptase | SE: anemia, neutropenia, hepatotoxicity | NC: monitor CBC, liver/renal, may take with or without food

Indinavir (Crixivan)

Protease inhibitor | Use: HIV infection | MOA: inhibits viral protease enzyme, preventing viral maturation | SE: insulin resistance, dyslipidemia, rash, GI upset | NC: monitor glucose/lipids, hydration, adherence, avoid St. John's wort

Palivizumab (Synagis)

Monoclonal antibody | Use: prevent RSV in high-risk infants | MOA: provides passive immunity to RSV | SE: injection site reaction, fever, rash | NC: IM monthly during RSV season, monitor for allergy

MMR Vaccine

Live vaccine | Use: prevent measles, mumps, rubella | MOA: induces antibody formation | SE: fever, rash, injection site pain | NC: contraindicated in pregnancy, avoid pregnancy 4 wks post, no live vaccines near time

RSV Vaccine

Inactivated vaccine | Use: prevent lower respiratory disease by RSV | MOA: stimulates antibody production | SE: fatigue, myalgia, fever | NC: IM before RSV season, adults >60 or maternal 32-36 wks

Haemophilus B Vaccine (Hib)

Conjugate vaccine | Use: prevent Haemophilus influenzae type B | MOA: induces immune antibody formation | SE: injection site redness, fever | NC: give at 2,4,6,12-15 months, not adults unless immunocompromised

Tdap/DTaP

Vaccine | Use: prevent tetanus, diphtheria, pertussis | MOA: induces antibody-mediated immunity | SE: soreness, fever, hives | NC: IM injection, pregnancy 27-36 wks, no aspirin post live vaccines

SEXUALITY & REPRODUCTION

Magnesium Sulfate

Electrolyte/tocolytic | Use: preeclampsia, preterm labor, seizure prevention | MOA: relaxes uterine muscle via calcium displacement | SE: flushing, hypotension, respiratory depression | NC: monitor RR, DTRs, urine, calcium gluconate available

Misoprostol (Cytotec)

Prostaglandin analog | Use: cervical ripening for labor induction | MOA: softens and dilates cervix, stimulates contractions | SE: uterine hyperstimulation, GI upset | NC: monitor contractions, fetal status, avoid in C-section history

Oxytocin (Pitocin)

Oxytocic hormone | Use: induce or augment labor, control postpartum bleeding | MOA: increases uterine contractions via calcium influx | SE: uterine rupture, water intoxication, HTN | NC: continuous fetal/uterine monitoring, stop if hyperstimulation

Betamethasone

Corticosteroid | Use: enhance fetal lung maturity between 24-34 wks gestation | MOA: increases surfactant synthesis | SE: edema, hyperglycemia, HTN | NC: give IM, monitor glucose

Surfactant (Beractant)

Respiratory agent | Use: prevent/treat neonatal respiratory distress | MOA: lowers alveolar surface tension preventing collapse | SE: bradycardia, hypoxia | NC: administer via ET tube, monitor oxygen, reposition infant

RhoGAM

Immune globulin | Use: prevent Rh isoimmunization in Rh-negative mothers | MOA: prevents antibody response to fetal Rh+ blood | SE: fever, chills, injection site pain | NC: IM at 28 weeks and 72h postpartum, monitor reaction

Erythromycin Ophthalmic Ointment

Macrolide | Use: prevent neonatal conjunctivitis | MOA: inhibits bacterial protein synthesis | SE: redness, eye irritation | NC: apply ribbon inner to outer canthus of eye

Vitamin K (Phytonadione)

Vitamin/coagulant | Use: prevent hemorrhagic disease in newborns | MOA: activates clotting factors | SE: pain at site, rash | NC: IM thigh injection, monitor jaundice

Combined Oral Contraceptive

Hormonal contraceptive | Use: prevent pregnancy, regulate cycles | MOA: suppress ovulation and LH surge | SE: nausea, HTN, DVT | NC: take same time daily, avoid smoking

Progestin-only Contraceptive

Hormonal contraceptive | Use: prevent pregnancy | MOA: thickens cervical mucus, inhibits ovulation | SE: weight gain, mood changes, fatigue | NC: take same time daily, backup if >3h late

Clomiphene (Clomid)

Ovulation stimulant | Use: induce ovulation for infertility | MOA: increases LH & FSH release | SE: hot flashes, multiple births, N/V | NC: monitor ovulation, educate on timing

Alendronate (Fosamax)

Bisphosphonate | Use: treat/prevent osteoporosis | MOA: inhibits bone resorption by osteoclasts | SE: esophagitis, GI upset | NC: take on empty stomach, upright 30 min, full glass water

Raloxifene (Evista)

SERM | Use: prevent/treat osteoporosis | MOA: mimics estrogen in bone | SE: hot flashes, DVT | NC: monitor leg swelling, encourage mobility

Testosterone

Androgen | Use: hormone replacement, delayed puberty, hypogonadism | MOA: stimulates male sex organ development, protein synthesis | SE: acne, aggression, hepatotoxicity | NC: monitor liver, lipids, mood, apply correctly