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Detailed information on the pharmacology of various medications, including anticonvulsants, antidepressants, and antibiotics. It covers topics such as the mechanism of action, therapeutic uses, precautions, contraindications, and monitoring requirements for these drug classes. Likely intended for healthcare professionals, such as nurses or pharmacy students, who need a comprehensive understanding of these medications and their clinical applications. The level of detail and the focus on specific drug-related parameters suggest that this document could be useful as study notes, lecture notes, or a summary for an academic course on pharmacology or clinical therapeutics.
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should be monitored on a regular basis. The therapeutic range is 4 to 12 mcg/L. Higher levels can lead to toxic symptoms consisting of initial adverse effects and also hypertension, tachycardia, ECG changes, stupor, agitation, nystagmus, urinary retention, respiratory depression, seizures, and coma. Children and elderly patient may develop toxicity levels below
CBC every 3 to 4 months Affects RBC, WBC, Platelets Agranulocytosis, Anemia
and has the unique ability to induce its own metabolism (autoinduction). Due to autoinduction, initial concentrations within therapeutic range may later fall despite good compliance. It also induces the metabolism of many CYP450 enzymes and other substances. Slowly but well absorbed half life of about 30 hours, shortens to 15 hours when given repeatedly The exact mechanism of action of carbamazepine is not known, but they are thought to affect the sodium channels, slowing influx of sodium in the cortical neurons and slowing the spread of abnormal activity. Carbamazepine exerts its effect by depressing transmission in the nucleus ventralis anterior of the thalamus. This area is associated with the spread of seizure discharge.
than the tablet form. Absorption from the immediate-release tablets is slow and erratic because of its slow water solubility. The drug is highly lipophilic, resulting in high body tissue binding.
monitored for seizure activity, severity, and duration. Patient should carry medical identification for the seizure disorder. Patient should report any mood changes or suicidal thoughts. Prevention of seizures. Do not abruptly end medication increases risk of seizures
: Patients taking topiramate may have decreased concentrations of bicarbonate due to inhibition of carbonic anhydrase and increased renal bicarbonate loss, leading to hyperchloremic metabolic acidosis. Severe metabolic acidosis has been reported in infants receiving a topiramate dose of 5mg/kg/day. Serum bicarbonate levels should be monitored at baseline and periodically throughout therapy.
disorder controlled with valproate?: Switch to another anti- seizure medication such as Keppra Use of these drugs during the first trimester of pregnancy is associated with neural tube defects
nightmares have been noted following abrupt discontinuance of the drug or after large dose decreases.
used to treat recalcitrant depression?: •Contraindica- tions Liver or kidney disease Hypersensitivity Congestive heart failure or arteriosclerotic disease Age over 60 years Pregnancy category C; excreted in breastmilk safety not established Not approved for use with children Postural hypotension and suppression of myocardial pain may occur.
norepinephrine and can cause hypertensive crisis. Foods high in tyramine should be restricted because of this risk as well as they are the precursor to dopamine, norepinephrine, and epinephrine.
pregnancy category A antibiotics and are safest prescribe in pregnancy.
cephalosporins, carbapenems, and monobactams, have similar mechanisms. They are most effective against rapidly growing organisms forming cell walls.
among gram-negative pathogens and anaerobes, amoxicillin and ampicillin are often combined with beta-lactamase inhibitors, clavulanic acid, and sulbactam, respectively, for enhanced gram-negative and anaerobic activity. Beta-lactamase inhibitors prevent the destruction of beta-lactam antibiotics by serv- ing as a competitive inhibitor of beta-lactamase.
prescribed to children. A penicillin is usually the drug of choice for a susceptible organism because of limited toxicities.
the guidelines related to prophylactic antibiotics prior to a dental appointment?: A joint task force from the American College of Cardiology and the American Heart Association recently published a document that currently recommends therapy only for those with prosthetic heart valves, previous infective endocarditis, certain patients with congenital heart disease, and cardiac transplant patients with valve regurgitation who are undergoing dental procedures that involve manipulation of either gingival tissue or the periapical region of the teeth. Patients with CHD who require prophylaxis include CHD repaired prophylaxis include those with unrepaired cyanotic CHD, completely repaired first 6 months after repair, and repaired CHD with residual effects at the site of the prosthetic patch or device.
non- infectious diarrhea related to antibiotic administration?: If severe diarrhea occurs, the patient
should contact the prescriber before initiating any treatment. For mild diarrhea, they can also use adsorbent antidiarrheal agents containing attapulgite (e.g., Donnagel) but should avoid antiperistaltic agents that promote the retention of toxins.
fluoroquinolones have a Black-Box Warning regarding the risk of ten- don rupture and tendonitis. The risk is increased in older patients; in patients taking coritocosteroids; and patients with heart, kidney, or lung transplant. An additional Black Box Warning has been issued for all fluoroquinolones to avoid this class in patients with myasthenia gravis.
patients for whom tetracyclines should be prescribed cautiously; such patients include those with renal impairment, those with hepatic impairment, pregnant women, lactating women, and children under the age of 8 years old. Doxycycline is Pregnancy category D. Others are Pregnancy category X and should not be used during pregnancy. They readily cross the placenta in concentrations up to 60% of maternal plasma. Tetracyclines are found in fetal tissue and can produce retardation of skeletal development in the fetus and staining of deciduous teeth. Children younger than 8 years generally should not use any tetracycline. These drugs form a stable calcium complex in any bone forming tissue, decreasing bone growth. They also may cause permanent yellow/gray/brown discoloration of decidu- ous and permanent teeth. Enamel hypoplasia has also been reported. Doxycycline
100mg/meal
Doxycycline, 100mg twice daily is the first line drug of choice for early treatment of Lyme disease, a tick borne infection caused by B. burgdorferi.
tanning lights should be avoided. Wear sunscreen, hats, and protective clothing if necessary to be in the sun for more than a few minutes. Differentiate between oral and parenteral vancomycin
tract is poor, although clinically significant serum concentrations have occurred. When administered intravenously, onset of action is rapid, with peak concentrations in 1 hour and a duration of effect of approximately 12 hours, depending on renal clearance. It is 52% to 56% protein bound and has less than 1% bioavailability by the oral route. Its half-life is 4 to 6 hours in adults and 2 to 3 hours in children. Distribution is wide, with 20% to 30% penetration of the CSF. The drug crosses the placenta.
subunit of susceptible organisms and may inhibit RNA-dependent synthesis by stimulating the disassociation of peptidyl-tRNA from ribosomes. These drugs are typically bacteriostatic but may be bactericidal depending on drug con- centrations and the bacterial species tested. Macrolides are weak bases, and their activity increases in alkaline media.
by reversibly binding to the 30S subunit of the bacterial ribosome and preventing the addition of amino acids to growing peptides.
supplementation will decrease peripheral neuropathy.
creatinine may be assessed prior to therapy in those with risk factors for renal impairment and periodically during prolonged therapy to detect changes in renal function.
treatment of influenza A and B.
Rifampin is also used to treat several nonmycobacterial infections. It is used as prophylaxis for close contacts of people with meningococcal infections caused by N. meningitis. Prophylaxis for H. influenzae type b Off label treatment of leprosy
to 20% of patients taking isoniazid. A small group of patients may progress to progress to hepatic failure or necrosis. The symptoms are those usually associated with the function of development of hepatitis, including abnormal liver function studies, jaundice, and fatigue.
prophylaxis, particularly when an unvaccinated high risk patient is exposed to influenza.
Therapy should be continued 1-2 weeks in candidiasis (3-5 days in vaginal candidi- asis).
Tissue nematodes--mebendazole, albendazole, or ivermectin
which appears to be dose related. S/S include--decreased visual acuity, red-green color blindness, diminished visual fields, and sometimes loss of vision Precipitation of gouty arthritis (elevated uric acid levels) Transient impairment of liver function Infrequent peripheral neuropathy
patients with scabies. It is effective in treating scabies in patients who are immunocompromised. The dose is 200 mcg/kg given in a single dose. Because Ivermectin is not ovicidal, it should be repeated in 1 to 2 weeks.
rifampin. A harmless orange-red discoloration of body fluids including tears, saliva, urine, sweat, CSF, and feces also occurs. Hematuria should not be confused with this discoloration because of hematuria may be an indication of a hypersensitivity reaction.