NSAIDs Pharmacology Lecture Notes Tissue Injury & Inflammatory Response Initial vasoconstriction occurs immediately after injury to minimize blood loss (temporary reaction) Chemical mediators released: histamines, kinins, and prostaglandins - crucial for inflammatory response Vasodilation follows - blood vessels widen, increasing blood flow to injured area Classic inflammatory symptoms: redness (erythema), swelling (edema), pain from nerve stimulation, fever/heat NSAIDs Classification & Examples Propionic derivatives: ibuprofen, naproxen Phenomates: mefenamic acid Available OTC: salicylates, propionic acid derivatives Prescription required: COX2 inhibitors, acetic acid derivatives, oxicams, phenomates Mechanism of Action COX enzymes: cyclooxygenase (COX1 & COX2) convert arachidonic acid to prostaglandins COX1: Always active, protects stomach lining, helps platelet aggregation COX2: Activated only during tissue injury, causes inflammation and pain NSAIDs inhibit COX enzymes, preventing prostaglandin production (prostaglandin inhibitors) Primary Effects Antipyretic: reduces fever Analgesic: pain relief Anticoagulant: prevents blood clots (especially aspirin) Specific Drug Categories Salicylates (aspirin): pain, inflammation, fever, anticoagulant effects Propionic acid derivatives: mild to moderate pain (1-6 on pain scale), inflammation, fever Acetic acid derivatives: more effective for inflammation but significant GI side effects COX2 inhibitors: second generation NSAIDs with better safety profile, target COX2 specifically Oxicams: long-term use for osteoarthritis/rheumatoid arthritis, longer half-life (once daily) Phenomates: especially effective for menstrual pain Major Side Effects Gastrointestinal Dyspepsia: heartburn, indigestion, abdominal pain, nausea Long-term risks: stomach lining damage, GI bleeding, perforation (holes in stomach/intestines) Bleeding signs to monitor: dark tarry stools, bleeding gums, petechiae, ecchymosis, purpura Higher risk patients: older adults, smokers, alcohol users, pre-existing ulcers Prevention: proton pump inhibitors or H2 receptor antagonists to reduce stomach acid Kidney Effects Impaired function: reduced urine output, fluid retention, weight gain, edema Monitor: BUN and creatinine levels for kidney function Mechanism: NSAIDs reduce blood flow to kidneys, worsening function and increasing kidney disease risk Cardiovascular Risk Non-aspirin NSAIDs increase heart attack and stroke risk Prescribe at smallest effective dose Special Considerations Menstrual Pain (Dysmenorrhea) Avoid aspirin for painful menstruation with heavy bleeding Use acetaminophen 2 days before and during first 2 days of menstrual period Aspirin-Specific Risks Salicylism/Aspirin toxicity: early symptoms from overdose, can progress to electrolyte imbalances, coma, respiratory depression Serum salicylate levels: >30 mg/dL mild toxicity, >50 mg/dL severe toxicity Treatment: activated charcoal, possible hemodialysis Reye's syndrome: rare but serious condition causing liver/brain swelling in children/adolescents recovering from viral infections (flu, chickenpox) Reye's syndrome symptoms: persistent vomiting, lethargy, confusion → irritability, aggression, disorientation, seizures, loss of consciousness Avoid aspirin in children/adolescents with viral infections Drug Interactions & Precautions Glucocorticoids: amplify stomach bleeding risk Alcohol: increases stomach bleeding - limit/avoid consumption Other NSAIDs: can negate heart protective effects of aspirin - space dosing apart Herbal supplements: garlic and ginseng enhance bleeding risk High-risk populations: older adults, smokers, certain health conditions (H7

NSAIDs Pharmacology Lecture NotesTissue Injury & Inflammatory Response

• Initial vasoconstriction occurs immediately after injury to minimize blood loss (temporary reaction)

• Chemical mediators released: histamines, kinins, and prostaglandins - crucial for inflammatory response

• Vasodilation follows - blood vessels widen, increasing blood flow to injured area

• Classic inflammatory symptoms: redness (erythema), swelling (edema), pain from nerve stimulation, fever/heat

NSAIDs Classification & Examples

• Propionic derivatives: ibuprofen, naproxen

• Phenomates: mefenamic acid

• Available OTC: salicylates, propionic acid derivatives

• Prescription required: COX2 inhibitors, acetic acid derivatives, oxicams, phenomates

Mechanism of Action

• COX enzymes: cyclooxygenase (COX1 & COX2) convert arachidonic acid to prostaglandins

• COX1: Always active, protects stomach lining, helps platelet aggregation

• COX2: Activated only during tissue injury, causes inflammation and pain

• NSAIDs inhibit COX enzymes, preventing prostaglandin production (prostaglandin inhibitors)

Primary Effects

• Antipyretic: reduces fever

• Analgesic: pain relief

• Anticoagulant: prevents blood clots (especially aspirin)

Specific Drug Categories

• Salicylates (aspirin): pain, inflammation, fever, anticoagulant effects

• Propionic acid derivatives: mild to moderate pain (1-6 on pain scale), inflammation, fever

• Acetic acid derivatives: more effective for inflammation but significant GI side effects

• COX2 inhibitors: second generation NSAIDs with better safety profile, target COX2 specifically

• Oxicams: long-term use for osteoarthritis/rheumatoid arthritis, longer half-life (once daily)

• Phenomates: especially effective for menstrual pain

Major Side EffectsGastrointestinal

• Dyspepsia: heartburn, indigestion, abdominal pain, nausea

• Long-term risks: stomach lining damage, GI bleeding, perforation (holes in stomach/intestines)

• Bleeding signs to monitor: dark tarry stools, bleeding gums, petechiae, ecchymosis, purpura

• Higher risk patients: older adults, smokers, alcohol users, pre-existing ulcers

• Prevention: proton pump inhibitors or H2 receptor antagonists to reduce stomach acid

Kidney Effects

• Impaired function: reduced urine output, fluid retention, weight gain, edema

• Monitor: BUN and creatinine levels for kidney function

• Mechanism: NSAIDs reduce blood flow to kidneys, worsening function and increasing kidney disease risk

Cardiovascular Risk

• Non-aspirin NSAIDs increase heart attack and stroke risk

• Prescribe at smallest effective dose

Special ConsiderationsMenstrual Pain (Dysmenorrhea)

• Avoid aspirin for painful menstruation with heavy bleeding

• Use acetaminophen 2 days before and during first 2 days of menstrual period

Aspirin-Specific Risks

• Salicylism/Aspirin toxicity: early symptoms from overdose, can progress to electrolyte imbalances, coma, respiratory depression

• Serum salicylate levels: >30 mg/dL mild toxicity, >50 mg/dL severe toxicity

• Treatment: activated charcoal, possible hemodialysis

• Reye's syndrome: rare but serious condition causing liver/brain swelling in children/adolescents recovering from viral infections (flu, chickenpox)

• Reye's syndrome symptoms: persistent vomiting, lethargy, confusion → irritability, aggression, disorientation, seizures, loss of consciousness

• Avoid aspirin in children/adolescents with viral infections

Drug Interactions & Precautions

• Glucocorticoids: amplify stomach bleeding risk

• Alcohol: increases stomach bleeding - limit/avoid consumption

• Other NSAIDs: can negate heart protective effects of aspirin - space dosing apart

• Herbal supplements: garlic and ginseng enhance bleeding risk

• High-risk populations: older adults, smokers, certain health conditions (H. pylori, hypovolemia, asthma, bleeding disorders)

Specific Drug ConsiderationsKetorolac

• Never use with advanced kidney disease

• Maximum 5 days of treatment

• Best for moderate to severe post-operative pain

• Routes: IV, IM for rapid onset, then PO

Celecoxib (COX2 Inhibitor)

• Caution with heart disease - increases heart attack and stroke risk

• Last resort for pain management

IV Ibuprofen

• Infuse over 30 minutes to minimize vascular irritation and hypotension

• Ensure adequate hydration to preserve renal function

Aspirin Surgery Considerations

• Discontinue 1 week before elective surgery unless prescribed for cardiovascular protection

Acetaminophen

• IV form: Ofirmev

• Mechanism: works in brain and spinal cord, blocks prostaglandin production, inhibits COX2

• Side effects: nausea, vomiting, headaches, insomnia

• Prolonged use: can affect liver function

Dosage Limits

• Most clients: no more than 4 grams per day

• Undernourished patients: no more than 3 grams per day

• Alcohol consumers (3+ drinks/day): no more than 2 grams per day

Toxicity & Treatment

• Medical emergency requiring ER treatment

• Antidote: acetylcysteine (Mucomist) via duodenal tube or IV to prevent vomiting/aspiration

• Monitor liver function: ALT, AST, bilirubin, alkaline phosphatase

Key Clinical Points

• Ibuprofen and diabetes: can mask hypoglycemia symptoms - use with caution

• Aspirin for prevention: low-dose (81mg) for stroke/heart attack prevention in high-risk patients

Antibiotic Classification and MechanismsNarrow vs Broad Spectrum Antibiotics

• Narrow spectrum: Target specific bacteria types when exact pathogen is known

• Reduce bacterial resistance risk and preserve normal flora

• Broad spectrum: Target wide variety (gram positive and negative)

• Used when bacteria not yet identified or in critical conditions awaiting lab results

Bactericidal vs Bacteriostatic

• Bactericidal: Directly kill bacteria ("the killers")

• Bacteriostatic: Prevent bacterial growth without direct killing

Antibiotic Selection Process

• Identify causative agent through body fluid analysis (blood, urine, sputum)

• Perform sensitivity tests to determine effective antibiotics

• Consider infection location, patient age, allergies, and immune status

• Testing methods: Gram stain (quick assessment) vs Culture (detailed, several days)

• Disk diffusion test: Bacteria sensitive if no growth near antibiotic disc

Key Laboratory Values

• MIC: Minimum concentration to stop bacterial growth

• MBC: Minimum concentration to kill 99.9% of bacteria

Nursing Responsibilities

• Collect specimens for culture testing

• Prevent contamination during sample collection

• Ensure accurate test results

Combination Therapy and ProphylaxisDrug Interactions

• Potentiating: One drug enhances the other's effect

• Antagonistic: Combined drugs less effective than separate use

• Additive: Combined effect equals sum of individual effects

Prophylaxis Use

• Preventive medication use to prevent infections before they occur

Major Antibiotic ClassesPenicillins

• Mechanism: Bactericidal - disrupts bacterial cell wall

• Side effects: Anaphylaxis, renal impairment, electrolyte imbalances (hyperkalemia >5 mEq/L, hypernatremia >145 mEq/L)

• Drug interactions: Cannot mix with aminoglycosides in same IV (inactivates both drugs)

• Administration: Give penicillin 1 hour before or after aminoglycosides using separate IV lines

• Probenecid interaction: Delays penicillin excretion, can cause kidney impairment

Cephalosporins (Five Generations)

• 1st generation: Effective against gram-positive bacteria

• 2nd & 3rd generation: Effective against gram-negative bacteria

• 4th generation: Effective against both gram-positive and gram-negative

• 5th generation: Effective against multi-drug resistant organisms

• Advantages: Better tissue penetration, longer half-lives, less frequent dosing improves compliance

• Side effects: Bleeding (interferes with vitamin K), thrombophlebitis at IV site

• Monitoring: Check IV site for swelling, redness, warmth, pain; rotate IV every 72 hours

• C. diff risk: Can cause pseudomembranous colitis - monitor for diarrhea

Vancomycin

• Uses: C. diff, staph, MRSA infections

• Administration: IV (most common), PO, or suppository

• Red Man Syndrome: Histamine release from rapid infusion causing flushing, rash, hypotension, tachycardia

• Prevention: Infuse over 60-90 minutes, pre-medicate with antihistamines

• Ototoxicity: Monitor for tinnitus, hearing loss, vertigo, ear pressure

Tetracyclines

• Mechanism: Bacteriostatic, prevents protein synthesis

• Uses: Acne, periodontal disease, STI treatment

• Contraindications: Children and pregnant women (tooth discoloration, enamel hypoplasia)

• Side effects: Photosensitivity, hepatotoxicity, reduces hormonal contraceptive effectiveness

Macrolides

• Mechanism: Bacteriostatic (bactericidal at higher doses)

• Unique risk: Prolonged QT intervals leading to cardiac dysrhythmias and potential sudden death

Aminoglycosides

• Mechanism: Bactericidal, effective for gram-negative bacteria

• Side effects: Ototoxicity, nephrotoxicity, neuromuscular blockade (muscle weakness)

• Monitoring: Peak and trough levels required

  • Trough: Lowest concentration, measured before next dose

  • Peak: Highest concentration, measured 30 minutes after dose completion

General Monitoring and SafetyAllergy Assessment

• Always ask about medication allergies before first dose

• Monitor for reactions: Immediate (2-30 min), accelerated (1-72 hours), delayed (days-weeks)

Treatment Effectiveness

• Post-treatment culture to confirm absence of microorganisms

• Clinical improvement (fever resolution, clear lung sounds)

Patient Education

• Complete entire course even if feeling better to prevent resistance

• For STI treatment: abstain from intercourse until negative culture results

Antibiotic Classification - Lecture NotesNarrow vs Broad Spectrum Antibiotics

• Narrow spectrum: Target specific bacteria types when exact pathogen is known

• Broad spectrum: Target wide variety (gram positive and negative) - used when bacteria not yet identified or in critical conditions

Bactericidal vs Bacteriostatic Mechanisms

• Bactericidal: Directly kill bacteria ("the killers")

• Bacteriostatic: Prevent bacterial growth without direct killing

Antibiotic Selection Process

• Identify causative agent through body fluid analysis (blood, urine, sputum)

• Testing methods: Gram stain (quick assessment) vs Culture (detailed, several days)

• Disk diffusion test: Bacteria sensitive if no growth near antibiotic disc

• MIC: Minimum concentration to stop bacterial growth

• MBC: Minimum concentration to kill 99.9% of bacteria

Combination Therapy Effects

• Potentiating: One drug enhances the other's effect

• Antagonistic: Combined drugs less effective than separate use

• Additive: Combined effect equals sum of individual effects

Major Antibiotic ClassesPenicillins

• Side effects: Anaphylaxis, hyperkalemia >5 mEq/L, hypernatremia >145 mEq/L causing dysrhythmias

• Critical drug interaction: Cannot mix with aminoglycosides in same IV (inactivates both drugs)

• Administration: Give penicillin 1 hour before or after aminoglycosides using separate IV lines

Cephalosporins (Five Generations)

• 1st generation: Gram-positive bacteria

• 2nd & 3rd generation: Gram-negative bacteria

• 4th generation: Both gram-positive and gram-negative

• 5th generation: Multi-drug resistant organisms

• Side effects: Bleeding (interferes with vitamin K), thrombophlebitis at IV site

• C. diff risk: Monitor for diarrhea as early sign of pseudomembranous colitis

Vancomycin

• Red Man Syndrome: Histamine release from rapid infusion causing flushing, rash, hypotension, tachycardia

• Prevention: Infuse over 60-90 minutes, pre-medicate with antihistamines

• Ototoxicity: Monitor for tinnitus, hearing loss, vertigo, ear pressure

Tetracyclines

• Contraindications: Children and pregnant women (tooth discoloration, enamel hypoplasia)

• Side effects: Photosensitivity, hepatotoxicity, reduces hormonal contraceptive effectiveness

Macrolides

• Unique risk: Prolonged QT intervals leading to cardiac dysrhythmias and potential sudden death

Aminoglycosides

• Side effects: Ototoxicity, nephrotoxicity, neuromuscular blockade (muscle weakness)

• Monitoring: Peak and trough levels required

• Trough: Lowest concentration, measured before next dose

• Peak: Highest concentration, measured 30 minutes after dose completion

Critical Nursing Actions

• Always ask about medication allergies before first dose

• Monitor for reactions: Immediate (2-30 min), accelerated (1-72 hours), delayed (days-weeks)

• Complete entire course even if feeling better to prevent resistance

• IV site monitoring: Check for swelling, redness, warmth, pain; rotate every 72 hours

Pharmacokinetics Lecture NotesDefinition and Overview

• Pharmacokinetics: Study of how drugs move within the body from administration to elimination

• Encompasses the complete "journey of medication" through four main stages

• Addresses key questions: How does medication reach target areas? What happens after administration?

Stage 1: Absorption

• Process: How medication enters the bloodstream

• Routes: Enteral (digestive system), parenteral (injection), sublingual, inhalation, topical, subcutaneous

• Key factors: Speed of absorption, strength (amount absorbed), and administration method all impact drug potency

Stage 2: Distribution

• Process: Transportation of medication to different body parts via bloodstream

• Circulation factor: Blood flow issues (e.g., heart disease) impede medication transport

• Cell membrane permeability: Medications pass through barriers to reach exclusive areas like the brain

• Plasma protein binding: Medications attach to proteins (albumin) for distribution - limited availability creates competition among multiple drugs ("musical chairs" effect)

Stage 3: Metabolism

• Process: Chemical alteration of drugs, primarily in the liver

• Purpose: Makes medication more water-soluble, less active, or inactive to facilitate excretion

• Other metabolic sites: Lungs, intestines, bloodstream (liver remains primary)

Factors Influencing Metabolism

• Age: Infants have immature digestive systems vs. elderly patients

• Enzyme levels: Can accelerate or slow metabolism

• First pass effect: Some drugs inactivated by liver on first pass - doctors may change route (PO to sublingual/injection) to avoid this

• Shared metabolic pathways: Multiple medications compete for same metabolic processes

• Nutrition: Poor diet lacks necessary ingredients for proper drug metabolism

Stage 4: Excretion

• Process: Removal of drugs and metabolites from the body

• Primary organ: Kidneys (main site for dumping medication remnants)

• Secondary sites: Liver and other organ systems also contribute to excretion

Pharmacology Lecture NotesDrug Half-Life

• Dosing frequency depends on half-life: every 4-6 hours, 3x daily, or 1-2x daily based on drug's half-life

Pharmacodynamics Overview

• Definition: Study of what a drug does in the body - how it produces both therapeutic and harmful side effects

Three Types of DrugsAgonist Drugs

• Bind to receptor, activate it, produce full biological response

• Analogy: Key that fully turns and opens the door

• Example: Morphine - binds to opioid receptors in brain/spinal cord for full pain relief

Partial Agonist Drugs

• Bind to receptor but produce weaker response than full agonist

• Analogy: Key that partially opens the door

• Example: Buprenorphine - provides milder pain relief effects

Antagonist Drugs

• Bind to receptor but block activation by other substances

• Analogy: Broken key that fits but doesn't turn

• Example: Naloxone - antidote to opioid overdose, blocks opioid receptors and reverses morphine effects

Routes of AdministrationOral/Enteral Medications - Safety First

• Do NOT give PO meds if patient:

  • Is vomiting

  • Has trouble swallowing

  • Is less alert

  • Has no gag reflex

• Best position: High Fowler's (90 degrees) to help with swallowing

• Food considerations: Medications that irritate stomach should be taken with food

• Grapefruit juice warning: Can affect drug effectiveness - avoid with medications

• Cannot crush: Enteric-coated or time-release tablets

Sublingual and Buccal Routes

• Enter bloodstream directly, bypass liver and first-pass effect

• Patient instructions: Keep tablet in place until dissolved, avoid eating/drinking for complete absorption

Nasal Administration

• Use aseptic technique: Hand hygiene, clean gloves, alcohol cleaning

• Review ATI for proper nasal drops and spray administration techniques

Rectal Suppositories

• Position: Start supine, then turn to left side (Sims position) - takes advantage of natural colon curve

• Post-insertion: Patient remains flat for 5 minutes to retain suppository and facilitate absorption

Vaginal Administration

• Preparation: Perineal care to ensure clean area, may need lubrication

• Insertion depths:

  • Suppositories: 3-4 inches deep in posterior vaginal wall

  • Creams/foams/jellies: 2-3 inches deep

• Post-administration: Patient lies down for 5 minutes

Inhalers

• Spacer benefits: Easier to use, more effective, increases lung delivery while decreasing throat deposition

• Technique: Shake 5-6 times to mix medication, patient exhales completely, closes lips around spacer, then inhales

NG/G-Tubes

• Preferred form: Liquid medications

• If crushing needed: Only crush one medication at a time (not multiple together)

• Special consideration: Sublingual drugs should still be given sublingually even with tubes present - maintains therapeutic effect

• Administration: Check tube placement, use gravity flow (no plunger), flush after to clear remaining medication

Parenteral InjectionsBest Injection Sites

• Ventrogluteal: Best for IM injections, especially >2cc volumes - away from major nerves/vessels

• Vastus lateralis: Best for infants - largest thigh muscle

• Deltoid: Adults, smaller muscle mass, limit to 1cc or 1ml

Injection Guidelines

• Tuberculin syringe: For small volumes <0.5ml

• Site rotation: Prevent tissue damage with repeated injections

• Avoid injecting: Edematous, inflamed areas, or areas with moles/birthmarks

Injection Types and Angles

• Intradermal: 10-15 degrees, for TB skin testing, do not massage site to avoid dispersing solution

• Subcutaneous: For small, non-irritating, water-soluble drugs (insulin, heparin), use areas with good fat pads

• Intramuscular: See angle chart

Needle Gauges

• Higher number = smaller needle, lower number = bigger needle

• 16 gauge: Trauma patients

• 18 gauge: Surgery and blood administration

• 22-24 gauge: Children, elderly, stable post-op patients

Z-Track Method

• Used for: Medications that stain skin or are irritating (e.g., iron preparations)

• Purpose: Prevents leakage into subcutaneous tissue, avoiding skin discoloration and irritation

Side Effects vs Adverse EffectsSide Effects

• Expected, unintended but not necessarily harmful

• Occur at therapeutic doses, mild and tolerable

• Examples: Drowsiness from Benadryl, dry mouth, mild nausea

• Physician may continue drug despite side effects

Adverse Effects

• Unintended AND harmful/undesirable effects

• Can occur at normal doses or from improper use/overdose

• Range: Mild to severe (life-threatening)

• Can be: Predictable or unpredictable (allergic/idiosyncratic reactions)

• Examples: Acetaminophen liver damage, penicillin allergic reactions

Drug Interactions

• Medications interact with: Other drugs, food, herbal remedies, supplements

• Example: Grapefruit juice can cause potential interactions

Contraindications vs Precautions

• Contraindications: STOP sign - medication should NOT be used because it can be harmful

• Precautions: YELLOW caution sign - medication should be used with extra care and monitoring, not a definite no but proceed with caution

Common Side Effect ProfilesCNS Effects

• CNS Depressants (e.g., opioids): Decreased brain activity → drowsiness, sedation

• CNS Stimulants (e.g., ADHD meds): Increased alertness/activity → seizure risk warning

Cardiovascular Effects

• Anti-hypertensives: Commonly cause orthostatic hypotension

Anticholinergic Effects

• Blocks acetylcholine → dry mouth, blurred vision, constipation, increased heart rate, urinary retention, reduced sweating, photophobia

Other Effects

• GI: Nausea, vomiting, stomach irritation

• Hematological: Bone marrow suppression/depression affecting blood and blood-forming organs

Drug Toxicity

• Can be fatal when patients take excessive dosages or take medication too frequently

• Acetaminophen example: causes liver damage in high amounts

Hepatotoxicity

• Many medications processed in liver - impacts drug processing if liver damaged

Symptoms:

• Fatigue, nausea, vomiting, loss of appetite

• Right upper quadrant abdominal pain

• Jaundice (yellowing of skin/eyes), dark urine, pale/clay-colored stool

• Pruritus (itching), ascites (abdominal swelling)

Lab Tests:

• ALT, AST, ALP, Bilirubin, Prothrombin time

Nephrotoxicity (Kidney Damage)Symptoms:

• Fatigue, nausea, vomiting, loss of appetite

• Oliguria (decreased urine output)

• Fluid retention/swelling in legs, ankles, feet, face

• Shortness of breath (fluid overload), hypertension

Lab Tests:

• BUN, creatinine, electrolytes (potassium, sodium)

Hypersensitivity/Allergic Reactions

• Immune response after exposure to substances like penicillin

• Body creates antibodies; subsequent exposure triggers allergic reaction

Mild Symptoms:

• Itching, rashes, watery eyes, sneezing

• Inflammation of nose and sinuses

Severe: Anaphylaxis

• Life-threatening reaction requiring immediate medical attention

• Affects all body systems (vs angioedema affecting face/neck)

• Initial signs: itching, redness, anxiety, weakness

• Can lead to respiratory failure if untreated

Angioedema

• Serious allergic reaction affecting deeper skin layers, blood vessels, subcutaneous tissue, mucous membranes

• Primarily affects face, lips, neck

• Medical emergency - throat swelling can block breathing

• Stridor (high-pitched breathing sound) indicates airway compromise

Treatment:

• Mild cases: antihistamines (diphenhydramine)

• Moderate/severe cases: corticosteroids to reduce swelling

Drug Interactions

• Combining drugs can increase/decrease therapeutic effects

• Can increase/decrease side effects or lead to toxicity

• Must warn patients about interactions with OTC drugs and herbal supplements

FDA Pregnancy Drug Categories

• Category A: Safest - no risk shown in studies

• Category B: Animal studies show no risk, limited human studies

• Category C: Animal studies show adverse effects, no human studies

• Category D: Evidence of human fetal risk, but benefits may outweigh risks

• Category X: Proven risk in animals and humans - risk outweighs benefits

TB and Airborne Precautions

• TB requires specific isolation room and special masks for nurses

Metronidazole (Antimicrobial/Anti-protozoal)

• Kills anaerobic organisms (microorganisms that don't require oxygen)

• Treats protozoal infections: giardiasis, trichomoniasis

• Pre-surgical prophylaxis for vaginal, abdominal, colorectal surgeries

• Combination therapy with tetracycline for H. pylori treatment

Side Effects & Complications

• GI discomfort: nausea, vomiting, dry mouth, metallic taste

• Take with food if metallic taste persists; contact provider if severe

• Dark urine (normal side effect, don't be alarmed)

• Neurotoxicity/CNS effects (concerning): numbness in hands/feet, ataxia, seizures

• Stop medication immediately and contact provider if neurotoxicity occurs

• Pseudomembranous colitis possible complication

Drug Interactions

• Alcohol: causes severe aversion reaction (nausea, vomiting, flushing) - unique to metronidazole

• Amplifies effects of warfarin, phenytoin, lithium (risk of toxicity)

• Reduces effectiveness of hormonal birth control

• Available oral or IV

STI Treatment Guidelines

• Avoid sexual activity during treatment and after completion

• Follow-up culture required to confirm infection clearance

Antifungal MedicationsAmphotericin B

• Used for systemic fungal infections (whole body)

Ketoconazole

• Used for superficial fungal infections (skin, nails, mucous membranes)

Mechanism of Action

• Attaches to fungal cells and inhibits growth, killing the fungus

• Effect depends on drug concentration

Nursing Actions for Amphotericin B

• Monitor for infusion reactions - stay with patient for 15 minutes

• Pre-treatment may include antihistamines or antipyretics

• Monitor kidney function and electrolyte levels

• Infuse slowly over 2-4 hours to reduce infusion reaction risk

Antiviral Drugs Lecture Notes

Overview

Short chapter on viral infections with reduced drug information

Focus on two main antiviral drugs: Acyclovir and Ganciclovir

Purpose: Stop virus from making copies of itself (like a stop sign in busy road)

Acyclovir

Therapeutic Uses

Cold sores on lips (herpes simplex)

Chicken pox (varicella zoster viral infection)

Ganciclovir

Therapeutic Uses

"Big gun" antiviral for patients with weakened immune systems

Targets cytomegalovirus in HIV/AIDS patients

Prevention of viral infections after organ transplant

Side Effects

Both Drugs

Phlebitis (inflammation)

Nephrotoxicity

Ganciclovir Specific

Weakens immune response further

Decreased white blood cell count (difficulty fighting infection)

Decreased platelet count (difficulty clotting blood)

Patient Education

Application Instructions

Use gloves when applying to skin

Ensure skin is clean and dry

Precautions

No intimate contact while active lesions present

No cure for herpes simplex - virus remains dormant

Drug Interactions

Acyclovir + Probenecid: Affects drug excretion from body

Ganciclovir + Cytotoxic drugs: Amplifies side effects

Effectiveness Indicators

Fewer or healed lesions

Key Facts About Herpes Simplex

Over 60% of adults have herpes simplex (often asymptomatic)

Type 1: Mouth sores, Type 2: Genital sores

Transmitted through kissing, sexual contact, sharing drinks/utensils

Important: Avoid stigma and judgment toward infected patients

Disease Overview

• Metabolic disease group characterized by chronic hyperglycemia (high blood glucose)

• Caused by defects in insulin secretion, insulin action, or both

Type 1 Diabetes Pathophysiology

• Autoimmune response destroying insulin-producing beta cells in pancreas

• Genetic predisposition - family history increases risk

• Insulin deficiency prevents glucose from entering cells effectively

• Body breaks down fats for energy → ketone production → diabetic ketoacidosis (dangerous condition)

Type 2 Diabetes Pathophysiology

• Insulin resistance - cells become less responsive to insulin

• Body requires higher insulin levels for same glucose uptake

• Contributing factors: genetic predisposition (unavoidable), obesity, physical inactivity (preventable)

• Beta cell dysfunction - pancreas produces less insulin over time

• Increased hepatic glucose production - liver resistance leads to more glucose release

Long-term ComplicationsMicrovascular (Small Blood Vessel Damage)

• Retinopathy (eye damage)

• Nephropathy (kidney damage)

• Neuropathy (nerve damage)

Macrovascular (Large Blood Vessel Damage)

• Cardiovascular disease

• Stroke/cerebrovascular accidents

Hypoglycemia SymptomsEarly Signs

• Shakiness, sweating, dizziness, hunger, irritability, palpitations, anxiety

Moderate Symptoms

• Confusion, difficulty concentrating, weakness, fatigue, blurred vision, headaches

Severe Symptoms

• Loss of coordination, unconsciousness, seizures, coma

Insulin TherapyMechanism of Action

• Hormone from pancreas that controls blood sugar levels

• Attaches to receptors on muscle, fat, and liver cells

• Activates cells to use glucose and convert to glycogen for storage

When Type 2 Patients Need Insulin

• Blood sugar too high despite pills, diet, and exercise

• Serious kidney/liver problems or neuropathy

• Surgery, medical tests, or extreme stress (injury/infection)

• Diabetic ketoacidosis or high potassium levels

Insulin Types - Onset, Peak, Duration Critical

• Onset: Time to start lowering blood glucose after administration

• Peak: Maximum strength period for glucose lowering

• Duration: Total time insulin continues lowering glucose

Insulin Complications

• Hypoglycemia from too much insulin or inadequate nutrition

• Hypokalemia - insulin moves potassium into cells

• Lipohypertrophy - abnormal fat masses from not rotating injection sites

Hypoglycemia TreatmentConscious Patients

• 15g carbohydrates: 4 oz orange juice, 2 oz grape juice, 8 oz milk, or glucose tablets

Unconscious Patients

• IV/subcutaneous glucagon - cannot give oral glucose

Oral AntidiabeticsSulfonylureas (Glipizide, Glyburide, Glimepiride)

• Help pancreas release more insulin by binding to beta cells

Metformin (Biguanide)

• Tells liver to make less glucose

• Helps body cells use insulin better

• Decreases sugar absorption

Critical Metformin Warning

• Excreted by kidneys - accumulates if kidney function compromised

• HOLD before CT scans/angiograms - contrast dyes impair renal function

• Can cause lactic acidosis - nausea, vomiting, confusion, shock, coma

Drug Interactions

• Beta blockers hide hypoglycemia symptoms (tachycardia, shakiness)

• Thiazide diuretics/glucocorticoids raise blood sugar, reduce insulin effectiveness

• Sulfonylureas/meglitinides with insulin cause additive hypoglycemia

Pharmacology Lecture: Tuberculosis and Anti-TB MedicationsTuberculosis Overview

• Causative agent: Mycobacterium tuberculosis bacterium

• Primary target: Lungs (can also affect spine, kidneys, brain)

• Transmission: Airborne through coughing, sneezing, speaking, singing

• Isolation: Requires airborne precautions

TB Pathophysiology

• Bacteria reaches alveoli where alveolar macrophages attempt destruction

• Waxy cell wall resists destruction, allowing bacteria to survive and replicate inside macrophages

• Infected macrophages release cytokines to attract other immune cells

• Formation of granuloma structure to contain infection

Latent vs Active TB

• Latent TB: Bacteria remains "sleeping" in healthy individuals - no symptoms, not contagious

• Reactivation triggers: Immunocompromise (HIV, diabetes, malnutrition, immunosuppressive drugs)

• Active TB symptoms: Persistent cough (>3 weeks), sputum production, hemoptysis, chest pain, fever, night sweats, weight loss, fatigue

TB Diagnosis

• Tuberculin skin test to detect immune response

• Chest X-ray for lung involvement imaging

• Sputum culture to identify Mycobacterium tuberculosis

• BCG vaccine scar indicates vaccination in high-prevalence countries (Asia, Philippines, Indonesia, India)

Isoniazid (Anti-TB Drug)

• Mechanism: Stops mycolic acid synthesis in bacterial cell wall

• Latent TB treatment: 9 months monotherapy, then combined with rifampin weekly for 3 months

• Contraindications: Children under 2, HIV patients, pregnant patients

Isoniazid Complications

• Hyperglycemia: Interferes with insulin secretion from pancreatic beta cells

• Peripheral neuropathy: Inhibits enzyme needed for vitamin B6 activation - prevent with pyridoxine supplementation

• Hepatotoxicity: Metabolized in liver creating toxic metabolites

Isoniazid Administration & Interactions

• Best taken: Empty stomach (1 hour before/2 hours after meals)

• With food: If stomach upset occurs

• Drug interactions: Increases phenytoin levels causing toxicity; avoid tyramine-rich foods (cheese, cured meats, red wine)

• Contraceptive interference: Recommend backup birth control method

Rifampin (Anti-TB Drug)

• Mechanism: Stops bacterial protein synthesis ("wrench in machinery")

• Unique characteristic: Red-orange pigmented compound causes discoloration of body fluids

• Affected fluids: Urine, sweat, tears, saliva, sputum, breast milk - harmless but alarming to patients

Rifampin Drug Interactions

• Warfarin: Reduces anticoagulant effect - monitor INR closely, frequent dose adjustments needed

• HIV medications: Reduces efficacy of HIV drugs

Treatment Effectiveness Monitoring

• Clinical improvement: Clear breath sounds, resolution of night sweats, return of appetite

• Laboratory indicator: 3 consecutive negative sputum cultures (must be consecutive, not intermittent)

• Treatment phases: Initial phase (2 months) kills bacteria, continuation phase (4-7 months) eliminates lingering bacteria