This document summarizes information on the treatment of various medical conditions including: - Treatment for active tuberculosis involving a multi-drug regimen over several months. - Potential allergic reactions to penicillin and cephalosporins. - Common adverse drug reactions for medications like acyclovir, nystatin, methotrexate, isotretinoin, timolol. - Superinfections that can develop after long-term antibiotic use and conditions they may cause. - Uses and side effects of medications for conditions like gout, hemorrhoids, scabies, nicotine withdrawal, acne.

1. Pharmacology Final Part 2…everything not on Part 1

2. What are adverse reactions to anti-infectives?

3. Treatment for Active TB Chemotherapy, or taking a drug to treat disease, is recommended for patients with active TB Anti-TB drugs are classified as primary or secondary agents to describe the way they are used in treating TB Most primaries are bactericidal and are necessary to sterilize the TB lesions Secondaries are generally less effective and more toxic than primary agents Regimen for adults and children that do not have HIV concurrently is: Isoniazid (INH), rifampin (RIF), & pyrazinamide (PZA) and either ethambutol (EMB) or streptomycin sulfate (SM) for 8 weeks EMB or SM can be added to the initial regimen if needed INH & RIF daily or two to three times per week for 16 weeks or up to 6 months Continue for 6 months beyond culture conversion

4. Cephalosporin & Penicillin & Allergies Penicillin & Allergies Allergies can develop at any time Nurses should take bp & pulse before giving IM injections to have baseline info Patient should be asked to wait 30 minutes after PO or IM before leaving clinic Anaphylatic shock reactions have occurred with both oral and parenteral penicillin therapy Cephalosporin & allergies Allergic reactions range from mild erythema to anaphylaxis

5. Tetracycline Teaching

6. Zovirax Acyclovir capsule, tablet, suspension Antiviral Indicated for the acute treatment of herpes zoster (shingles); the initial episodes and management of recurrent episodes of genital herpes; and the treatment of chickenpox Can cause anaphylaxis, angioedema, fever, headache, pain, ataxia, coma, delirium, dizziness, seizure, diarrhea, N/V, GI distress, anemia, leukopenia, jaundice, pruritus, urticaria, alopecia

7. Nystatin Antimycotic poly-ene antibiotic Indicated for treatment of candidiasis In the oral cavity Well tolerated even with prolonged treatment Can cause: diarrhea, N/V, GI upset, rash/urticaria, tachycardia, myalgia

8. What is a superinfection & when would you expect to develop it? Superinfections are infections that result from antibiotic use Organisms that are not sensitive to a prescribed antibiotic (i.e. yeast) are able to multiply, overgrow, and get out of control because the antibiotic also killed the organisms that would’ve kept them under control You would expect to develop them after using broad spectrum antibiotics mostly, particularly after long term use of the broad spectrum antibiotic Reactions like diarrhea, oral thrush, and vaginal itching are examples

9. Adverse reactions to antineoplastics

10. Nausea & Antineoplastics Antiemitics may be prescribed for nausea Dehydration must be avoided Meals should be made as palatable as possible If patient is unable to eat, holding ice chips in the mouth may bring some relief

11. Methotrexate Can cause severe complications or even death Antineoplasticantimetabolite indicated for use in patients with malignancy, psoriasis, and rheumatoid arthritis that have not responded to other treatments NOT for use in pregnant women or patients with impaired renal function SE: bone marrow suppression, aplastic anemia, GI toxicity, fetal death, bone marrow/liver/lung/kidney toxicity, fibrosis, cirrhosis, diarrhea and ulcerative stomatitis, potentially fatal skin reactions/opportunistic infections, N/V, gingivitis, pericarditis/effusion, hypotension… Monitor vital signs; monitor for abdominal pain, diarrhea, stomatitis, bone marrow depression, intake/output ratio and weights daily Apply pressure to venipuncture sites for 10 minutes Monitor for symptoms of pulmonary toxicity which may present as dry, nonproductive cough Monitor serum levels every 12-24 hours during high-dose therapy sessions With high dose therapy sessions patient must receive Leucovorin rescue every 24-48 hours

12. Why get immunizations? Immunizations are important to protect patients from communicable, preventable diseases

13. PPD & Toxoids PPD = purified protein derivative…it is used in screening procedures to identify people who have been exposed to a specific disease or who may have an active disease such as TB Toxoids = a weakened, attenuated toxin that can be used to produce immunity because the body cannot distinguish between the toxin and the toxoid…the most common example is the use of the tetanus toxoid to protect patients from Clostridium tetani

14. Vaccines are… Artificially Acquired Active Immunity = immunity acquired through the use of live or attenuated antigens in the form of vaccines

15. Muscle Relaxants Limit the transmission or movement of impulses in the motor pathways at the level of the spinal cord and brainstem, or they interfere with the mechanism that shortens skeletal muscle fibers Main action is to reduce muscle tone and involuntary movement without loss of voluntary motor function…other actions include mild sedation, reduction of anxiety and tension, and changes in pain perception Used to relieve pain in musculoskeletal and neurologic disorders involving peripheral injury and inflammation, often used after trauma Can be habit forming…long term use is NOT recommended Not for use in children or rec. for use in patients with a history of alcohol/drug abuse

16. Antigout Meds

17. NSAIDs

18. Gout A form of arthritis caused when the body makes too much or does not get rid of enough uric acid High levels of uric acid cause the excess uric acid to form crystals usually in the kidneys and in joint spaces These crystals have long, sharp, and jagged edges that can tear and bruise the tissues with which they come in contact

19. Anorectal Meds Include emollients, foams, and gels for topical anesthesia or healing of the rectal area Used for symptomatic relief of discomfort from hemorrhoids May be used on long-term basis or briefly Dibucaine, hydrocortisone acetate, zinc sulfate monohydrate, and hydrocortisone foam

20. Elimite/Permethrin Topical scabicidal indicated for the treatment of infestation with Sarcoptesscabiei Massage into skin from head to soles of feet Scabies rarely infests the scalp of adults, although the hairline, neck, temple, and forehead may be infested on infants and in geriatrics Cream should be removed by washing after 8 to 14 hours One treatment is generally curative Persistent pruritis is common and is not indicative of treatment failure; living mites after 14 days indicates that retreatment is necessary

21. Nicotine patches Adjunct therapy in the management of nicotine withdrawal 70% of nicotine released from the system is absorbed through the skin Enters breast milk 1-2 hr half life; rapid onset; 2-4 hour peak Can cause: headache, insomnia, pharyngitis, burning at patch site, erythema, pruritus Monitor for signs of overdose/toxicity…N/V, diarrhea, increased salivation, abdominal pain, dizziness, auditory or visual disturbances, weakness, hypotension, or irregular pulse Can be worn for 16-24 hours

22. Differin gel/Adapalene Indicated for the topical treatment of acne vulgaris in patients 12 years and older On face and any other affected areas of the skin once daily in the evening after cleansing gently with non medicated soap Can cause itching, erythema, and mild pruritus

23. Proparacaine Opthalmic medication Provides brief local anesthesia to allow measurement of intraocular pressure, removal of foreign bodies, or other superficial procedures Repeated use may result in increased risk of CNS and cardiovascular toxicity Adults and children…1-2 drops of 0.5% solution (single dose)

24. MucoMyst Acetylcysteine Antidote and mucolytic indicated for management of potentially hepatotoxicoverdosage of acetaminophen and the management of conditions associated with thick viscid mucous secretions Use cautiously with severe respiratory insufficiency, asthma or history of bronchospasm SE: drowsiness, vasodilation, rhinorrhea, N/V, stomatitis, rash, pruritus, urticaria When used as an antidote, assess for anaphylactoid reaction, monitor AST/ALT, and bilirubin levels along with prothrombin every 24 hrs for 96 hrs Monitor cardiac and renal function (creatinine, BUN), serum glucose, and electrolytes As an antidote it is most effective when given within 8 hours of ingestion…dilute in DW5

25. Accutane/Isotretinoin Indicated for the treatment of severe recalcitrant nodular acne Causes birth defects…not for use in pregnant women Only approved for marketing to fertile women through iPledge program run by FDA…must be dispensed through a pharmacy to patients who have been registered and meet all the requirements of iPledge which is a series of questions/requirements about pregnancy testing and 2 forms of contraception Related to vitamin A and retinoic acid 15 to 20 week courses of therapy Adverse reactions are similar to those reactions seen in patients taking very high doses of Vitamin A: Chelitis Hypertriglyceridemia Allergic reactions including: vasculitis, systemic hypersensitivity, Edema Fatigue Lymphadenopathy Weight loss Tachycardia Stroke Inflammatory bowel disease Anemia Thrombocytopenia Myalgia Pseudomotorcerebri Suicidal ideation

26. Timoptic/Timololmaleate Opthalmic Non-selective beta-adrenergic blocking agent indicated for the treatment of intraocular pressure in patients with ocular hypertension or open-angle glaucoma Patients should have a determination of intraocular pressure approximately 4 weeks after first treatment Most frequent adverse reactions are burning/stinging upon application…others include: Headache Bradycardia, arrhythmia, hypotension, hypertension, syncope, heart block, CVA N/V, diarrhea, dyspepsia, anorexia Lupus Dizziness, paresthesia, somnolence, insomnia, depression Alopecia, rash angioedema