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Discussion Main Pharmacy

Topic Option 1: Let’s say John calls into the office and is requesting a refill for his prescription narcotic, Percocet. He just received a 30-day supply of Percocet less than two weeks ago. He becomes irate that it cannot be filled. How should you handle John’s phone call? Should you make the doctor aware he is already out of his Percocet? What schedule drug does Percocet fall into? What are the potential dangers with John’s situation?

Plagiarism is a serious penalty; please make sure to use your own words and provide citations and references for any sources you utilize in your responses.
The citation (i.e. DeVore, 2015) follows any sentence that reflects information you learned from the book. All initial responses to the DQs require at least one reference.
Reminder: Use your own words when writing your post. You should include the reference at the bottom of your post should appear as follows: For example: 
Reference
DeVore, A. (2015). The electronic health record for the physician’s office. St. Louis, MO: Elsevier.Essentials of Pharmacology for Health Professions

Eighth Edition

Chapter 16

Gastrointestinal Drugs

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1

Introduction (1 of 2)

Gastrointestinal drug categories

Antacids

Drugs for treatment of ulcers and gastroesophageal reflux disease (GERD)

Antispasmodics

Management of inflammatory bowel disease

Antidiarrheal agents

Antiflatulents

Laxatives and cathartics

Antiemetics

 

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Introduction (2 of 2)

The following slides discuss various gastrointestinal drugs

Refer to the chapter for specific side effects, contraindications, and interactions

 

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Antacids

Act by partially neutralizing gastric hydrochloric acid

Widely available in many over-the-counter (OTC) preparations for the relief of indigestion, heartburn, and sour stomach

Generally have a short duration of action, requiring frequent administration

May contain aluminum, calcium carbonate or magnesium and sodium

 

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Agents for Treatment of Ulcers and GERD (1 of 3)

H2-blockers

Reduce gastric acid secretion by acting as histamine2 blockers (Example: Pepcid)

Reduce gastric acid released in response to stimuli

Proton pump inhibitors (PPI)

May be used long-term for severe GERD, to prevent NSAID-induced ulcers, and for hypersecretory conditions

Omeprazole: gastric antisecretory agent

 

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Agents for Treatment of Ulcers and GERD (2 of 3)

Gastric mucosal agents

Misoprostol (Cytotec)

Synthetic form of prostaglandin E1

Inhibits gastric acid secretion and protects the mucosa from the irritant effect of certain drugs

Sucralfate (Carafate)

Inhibitor of pepsin, given on an empty stomach

Reacts with HCl to form a paste that adheres to the mucosa, protecting the ulcer from irritation

 

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Agents for Treatment of Ulcers and GERD (3 of 3)

Helicobacter pylori treatment

Bacterial infection

Treated successfully with multiple-drug regimens (over 14 days).

See Chapter 17

See Table 16-1

 

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Antispasmodics/Anticholinergics

Help to calm the bowel

Work by decreasing motility (smooth muscle tone) in the GI tract

Dicyclomine (Bentyl)

Used for treatment of irritable bowel syndrome and other functional disturbances of GI motility

 

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Agents for Inflammatory Bowel Disease

Inflammatory bowel disease (IBD)

Chronic condition that causes inflammation in the lining of the GI tract

Includes Crohn’s disease and ulcerative colitis

Salicylates

Designed to reach the ileum and colon, bypassing the stomach and upper intestines

Examples: mesalamine and sulfasalazine used for Crohn’s disease and ulcerative colitis

Glucocorticoids

 

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Antidiarrheal Drugs (1 of 3)

Act in various ways

Reduce the number of loose stools

Patients experiencing diarrhea are instructed to stay hydrated

Salicylates

Bismuth subsalicylate (e.g., Kaopectate, Pepto-Bismol) has anti-infective and antisecretory properties, a direct mucosal protective effect, and weak antacid and anti-inflammatory effects

 

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Antidiarrheal Drugs (2 of 3)

Opiate agonists

Act by slowing intestinal motility, allowing for more reabsorption of fluid

Example: Loperamide

Probiotics

Living microorganisms that can alter a patient’s intestinal flora; may provide benefit in numerous GI diseases

Lactobacillus

Saccharomyces boulardii (Florastor)

 

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Antidiarrheal Drugs (3 of 3)

Clostridium difficile infection

One of the most common causes of infectious diarrhea in the United States

Symptoms include watery diarrhea, nausea, and/or abdominal pain or tenderness

Caused by eradication of native intestinal flora with broad-spectrum antimicrobials and overuse of PPI and H2-blocker therapy

Oral medications include metronidazole (Flagyl) or vancomycin

 

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Antiflatulents

For the symptomatic treatment of gastric bloating and postoperative gas pains

Help to break up gas bubbles in the GI tract

Simethicone

See Table 16-2

 

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Laxatives and Cathartics (1 of 4)

Laxatives promote evacuation of the intestine and are used to treat constipation

Included in this category are cathartics, or purgatives

Promote rapid evacuation of the intestine and alteration of stool consistency

Divided into seven categories according to action (see Chapter text for list)

 

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Laxatives and Cathartics (2 of 4)

Bulk-forming laxatives

Soften the stool by absorbing water and increase fecal mass to facilitate defecation

Stool softeners

Surface-acting agents that moisten stool through a detergent action

Emollients

Promote stool movement through the intestines by softening and coating the stool

 

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Laxatives and Cathartics (3 of 4)

Saline laxatives

Promote secretion of water into the intestinal lumen

Should be taken infrequently, in single doses

Stimulant laxatives

Cathartic in action; produce strong peristaltic activity; may alter intestinal secretions in several ways

Produce some degree of abdominal discomfort

 

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Laxatives and Cathartics (4 of 4)

Osmotic laxatives

Exert an action that draws water from the tissues into the feces and reflexively stimulates evacuation

Chloride channel activator

Lubiprostone increases intestinal fluid secretion by activating chloride channels in the epithelium

Mu-opioid receptor agonist

Opioid induced constipation

See Table 16-3

 

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Antiemetics (1 of 4)

For the prevention or treatment of nausea, vomiting, vertigo, or motion sickness

Many different products are available, varying in their actions, condition treated, and route of administration

See Table 16-4

 

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Antiemetics (2 of 4)

Anticholinergics

Dimenhydrinate (Dramamine) or scopolamine: for the treatment of motion sickness

Available in a transdermal patch

Meclizine (Antivert): antihistamine for the prevention and treatment of nausea, vomiting, and/or vertigo associated with motion sickness

 

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Antiemetics (3 of 4)

Antidopaminergics

Dopamine receptor antagonists interfere with the stimulation of chemoreceptor trigger zone (CTZ) in the brain, thereby blocking messages to the GI tract

Most frequently used agents to control nausea and vomiting in this class:

Prochlorperazine (Compazine): no longer marketed, caused extrapyramidal reactions

Phenergan, Reglan

 

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Antiemetics (4 of 4)

Serotonin receptor antagonists

Preferentially block serotonin receptors found centrally in the CTZ and peripherally in the intestines to control emesis

Serotonin is a major neurotransmitter involved in emesis located in the gut

Ondansetron (Zofran) and dolasetron (Anzemet)

For the prevention and treatment of post-operative (PONV) and chemotherapy-induced nausea and vomiting (CINV)

 

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Essentials of Pharmacology for Health Professions

Eighth Edition

Chapter 17

Anti-infective Drugs

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Introduction

Treatment of infection

Complicated by the great variety of medications available and their differing modes of action

First step: identify the causative organism and specific medication to which it is sensitive

Culture and sensitivity (C&S) tests

Wound, throat, urine or blood

Usually not available for 24-48 hours

 

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Resistance (1 of 2)

Organisms may build up resistance to drugs and are therefore, no longer effective because of:

Frequent use

Incomplete treatment

Anti-infective resistance is caused by many factors

Complex strategies needed to combat the problem

Seventy percent of bacteria that cause HAI’s are resistant to at least one drug

Example: MRSA

 

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Resistance (2 of 2)

Selection of anti-infective drugs

Infection site

Status of hepatic and/or renal function

Patient age

Pregnancy or lactation

Likelihood of organisms developing resistance

Known allergy to the anti-infective drug

 

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Adverse Reactions

Three categories

Allergic hypersensitivity

Over-response of the body to a specific substance (anaphylaxis)

Direct toxicity

Results in tissue damage

Indirect toxicity or superinfection

Manifested as a new infection due to absence of normal flora in the intestines or mucous membranes

 

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Vaccines/Immunizations

Centers for Disease Control and Prevention (CDC)

Currently recommends routine vaccination

Prevent 17 vaccine-preventable diseases that occur in infants, children, adolescents, or adults

Information regarding vaccines and immunizations changes from time to time and requirements may vary by state, territory, or country

 

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Antibiotics

Refers to a large spectrum of medicines that are useful for treating and preventing infections by bacteria.

No effect on viruses, fungal or other types of infection

Improper use causes resistance

Side effects, precautions, contraindications and interactions are listed for each drug. Refer to the Chapter text.

 

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Aminoglycosides

Treats many infections caused by:

Gram-negative bacteria (e.g., Escherichia coli and Pseudomonas)

Gram-positive bacteria (e.g., Staphylococcus aureus)

Effective in short-term treatment of many serious infections

Septicemia (e.g., bacteria in bloodstream causing low blood pressure) when less toxic drugs are ineffective or contraindicated

 

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Cephalosporins

Semisynthetic beta-lactam antibiotic derivatives produced by a fungus

Related to penicillins

Some patients allergic to penicillin are also allergic to cephalosporins

Classified as first, second, third, or fourth, or fifth generation

According to organisms susceptible to their activity

 

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Macrolides

Treats many infections of the respiratory tract, skin conditions, or for some sexually transmitted infections

Considered among the least toxic antibiotics

Preferred for treating susceptible organisms under conditions in which more toxic antibiotics might be dangerous

 

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Penicillins

Beta-lactam antibiotics produced from certain species of a fungus

Treats many streptococcal and some staphylococcal and meningococcal infections

Drug of choice for treatment of syphilis

Used prophylactically to prevent recurrences of rheumatic fever

 

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Carbapenems

Belong to the beta-lactam class of antibiotics

Have a very broad spectrum of activity against gram-negative and gram-positive organisms

Primary treatments include pneumonia, febrile neutropenia, intra-abdominal infections, diabetic foot infections, and significant polymicrobial infections

See Table 17-1

 

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Quinolones

For adult treatment of some infections of the urinary tract, sinuses, lower respiratory tract, GI tract, skin, bones, and joints, and in treating gonorrhea

Some organisms are showing increased resistance

Reserve for infections that require therapy with a fluoroquinolone

 

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Tetracyclines

Broad-spectrum antibiotics

Treats infections caused by Lyme disease, rickettsia, chlamydia, or some uncommon bacteria

Some organisms are showing increasing resistance

Use only when other antibiotics are ineffective or contraindicated

 

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Antifungals (1 of 3)

Treat specific susceptible fungal disease

Medications are quite different in action and purpose

Amphotericin B

Administered IV for the treatment of severe systemic and potentially fatal infections caused by susceptible fungi, including Candida

 

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Antifungals (2 of 3)

Fluconazole (Diflucan)

Works against many fungal pathogens, including most Candida, without the serious toxicity of amphotericin B

Micafungin (Mycamine)

Given IV

Provides new treatment options against Candida and Aspergillus species

 

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Antifungals (3 of 3)

Nystatin

Structurally related to Amphotericin B

Orally treats oral cavity candidiasis

Also used as a fungicide in the topical treatment of skin and mucous membranes

 

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Antituberculosis Agents

Tuberculosis (TB)

Caused by a bacterium called Mycobacterium tuberculosis, which primarily attacks the lungs

Antituberculosis agents are administered for two purposes

To treat latent or asymptomatic infection (no evidence of clinical disease)

For treatment of active clinical tuberculosis and to prevent relapse

Treatment can be challenging

See Table 17-2

 

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Miscellaneous Anti-Infectives (1 of 3)

Clindamycin

Treats serious respiratory tract infections, septicemia, osteomyelitis, serious infections of the female pelvis caused by susceptible bacteria, and for Pneumocystis jirovecii pneumonia associated with AIDS

Prophylactic use in dental procedures for penicillin-allergic patients

May be a viable therapeutic option for community-acquired MRSA

 

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Miscellaneous Anti-Infectives (2 of 3)

Metronidazole (Flagyl)

Synthetic antibacterial and antiprotozoal agent

Effective against protozoa

One of the most effective drugs against anaerobic bacterial infections

Also useful in treating Crohn’s disease, antibiotic-associated diarrhea, rosacea, and H. pylori infection

 

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Miscellaneous Anti-Infectives (3 of 3)

Vancomycin

Structurally unrelated to other available antibiotics

IV vancomycin is used in the treatment of potentially life-threatening infections caused by susceptible organisms

Drug of choice for MRSA

 

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Agents for VRE

Linezolid (Zyvox)

Indicated for gram-positive infections

Approved for the treatment of bacterial pneumonia skin, skin structure infections, and MRSA and VRE infections

Effective in treating diabetic foot infections

Administered by IV infusion or orally

See Table 17-3

 

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Sulfonamides

Among the oldest anti-infectives

Increasing resistance of many bacteria has decreased the clinical usefulness of these agents

Used most effectively in combinations with other drugs

Example: sulfamethoxazole and trimethoprim

Resistance develops more slowly

 

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Urinary Anti-Infectives

Urinary tract infection (UTI)

Symptomatic inflammatory response from the presence of microorganisms in the urinary tract

One of the most common bacterial infections for which patients seek treatment

First-line urinary anti-infectives for empiric treatment of uncomplicated lower UTI are sulfamethoxazole-trimethoprim and nitrofurantoin

See Table 17-4

 

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Antivirals

Acyclovir

Primarily treats herpes simplex, herpes zoster (shingles), and varicella zoster (chickenpox) infections

Neuraminidase inhibitors

Indicated for the treatment of uncomplicated acute illness due to influenza types A and B

Ribavirin

Treats infants and young children with respiratory syncytial virus (RSV) infections via nasal and oral inhalation, Lassa fever and Hepatitis C

See Table 17-5

 

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Treatment of HIV/AIDS Infections (1 of 4)

See Table 17-6

Highly specialized field

Those actively practicing in that field must be updated frequently on the many new medications and frequently changing protocols

Treatment of HIV infection

Consists of using highly active antiretroviral therapy (HAART) combinations of three or more antiretroviral (ARV) agents

 

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Treatment of HIV/AIDS Infections (2 of 4)

Antiretroviral protease inhibitors (PIs)

Block the activity of the HIV enzyme essential for viral replication late in the virus life cycle

Nucleoside reverse transcriptase inhibitors (NRTIs)

Inhibit an enzyme responsible for viral replication early in the virus life cycle

 

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Treatment of HIV/AIDS Infections (3 of 4)

Non-nucleoside reverse transcriptase inhibitors (NNRTIs)

Inhibit an enzyme responsible for viral replication early in the viral life cycle

Fusion inhibitors (FIs)

Block entry of HIV into cells, which may keep the virus from reproducing

 

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Treatment of HIV/AIDS Infections (4 of 4)

CCR5 antagonists

Block a co-receptor required for HIV entry into human cells

Integrase inhibitor

Raltegravir (Isentress): first ARV designed to slow the advancement of HIV infection by blocking the enzyme needed for viral replication

 

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HIV Information and Resources

Sources of current recommendations for clinical use of antiretrovirals (ARVs)

Department of Health and Human Services

Florida/Caribbean Aids Education and Training Center

AETC National Resource Center Drug Interactions

Johns Hopkins HIV Guide

National HIV Telephone Consultation Service

University of California, San Francisco

 

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Essentials of Pharmacology for Health Professions

Eighth Edition

Chapter 18

Eye and Ear Medications

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Introduction (1 of 2)

Most common eye diseases in Americans 40 years and older

Age-related macular degeneration, glaucoma, cataracts, and diabetic retinopathy

Conjunctivitis: inflammation of the conjunctiva (“pink eye”)

One of the most frequent causes of patient seeking help

Allergens, irritants, abrasion, bacteria and viruses are common causes

 

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Introduction (2 of 2)

Medications for the eye

Anti-infectives

Anti-inflammatory agents

Antiglaucoma agents

Mydriatics (pupil dilation)

Local anesthetics

The following slides discuss various eye medications

Refer to the chapter for specific side effects, contraindications, and interactions

 

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Anti-Infectives

Treat superficial eye infections caused by susceptible organisms

Ointments are preferable to drops in children and patients with poor adherence

Drops are preferred in adults

Ointments will cause blurring of vision for 20 minutes after instillation

Determine causative organism when possible

Preparations can be single or in combination

Antivirals

 

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Anti-Inflammatory Agents (1 of 4)

Relieve eye or conjunctiva inflammation in allergic reactions, burns, postoperatively, or irritation from foreign substances

Corticosteroids

Useful in acute stages of eye injury

Prevent scarring, for severe symptoms, or when condition is unresponsive to other medications

Do not use for extended periods of time

 

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Anti-Inflammatory Agents (2 of 4)

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Treat postoperative inflammation following cataract surgery

Alternative to corticosteroids if a contraindication exists

Immunologic agents

Increases tear production in patient’s with dry eye

 

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Anti-Inflammatory Agents (3 of 4)

Antihistamines/decongestants

Block histamine receptors in conjunctiva, relieving ocular pruritis associated allergic conjunctivitis

Cause vasoconstriction of blood vessels, providing relief from minor eye irritation and redness

 

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Anti-Inflammatory Agents (4 of 4)

Ophthalmic lubricants

Provide a barrier function at the level of the conjunctival mucosa

Help to dilute and flush various allergens and inflammatory mediators that may be present on the ocular surface

See Table 18-1

 

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Antiglaucoma Agents (1 of 5)

Glaucoma

A group of sight-threatening diseases of the eye in which there is increased intraocular pressure (IOP) due to obstruction of outflow of aqueous humor

Causes deterioration of and damage to the optic nerve resulting in vision loss

 

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Antiglaucoma Agents (2 of 5)

Glaucoma types

Acute (angle-closure) glaucoma

Characterized by a sudden onset of pain, blurred vision, and a dilated pupil

Considered a medical emergency

Chronic (open-angle) glaucoma

Much more common, often bilateral

Develops slowly over a period of years with few symptoms except a gradual loss of peripheral vision and possibly blurred vision

 

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Antiglaucoma Agents (3 of 5)

Antiglaucoma drugs given to lower intraocular pressure

Carbonic anhydrase inhibitors: reduce formation of hydrogen and bicarbonate ions

Diuretic effect; reduces production of aqueous humor

Miotics: cause pupil to contract

Reduce IOP by increasing aqueous humor outflow

 

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Antiglaucoma Agents (4 of 5)

Beta-adrenergic blockers: used topically to lower IOP in open-angle glaucoma

Decreased rate of aqueous humor production

Alpha agonists: decreases formation and increases outflow of aqueous humor

Minimal effects on cardiovascular or pulmonary hemodynamics

 

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Antiglaucoma Agents (5 of 5)

Prostaglandin analogs: greatest reduction in IOP by increasing outflow of aqueous humor

May be used concomitantly with other topical ophthalmic drugs to lower IOP

See Table 18-2

 

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Mydriatics

Topically dilates the pupil for ophthalmic examinations

Example: atropine

Also acts as a cycloplegic (paralyzes the muscles of accommodation)

Drug of choice in eye examinations for children

Often used for adults because of fast action and fast recovery time

 

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Local Anesthetics

Applied topically to the eye for minor surgical and diagnostic procedures, removal of foreign bodies, or painful injury

Example: tetracaine (TetraVisc)

See Table 18-3

 

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Otic (Ear) Medications (1 of 3)

Made up of three parts: outer, middle and inner

Serve two purposes: hearing and balance

Common ear conditions

Ear infections

Earwax (cerumen) buildup

Otitis media

Bacteria in the middle ear which leads to inflammation

Treatment includes an antibiotic and NSAIDS

 

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Otic (Ear) Medications (2 of 3)

Topical preparations for ear infections

“swimmers ear” or otitis externa

Cipro, Floxin and Cortisporin are the most common

Prescribed for 7-14 days

Drops that are designed to treat pain and inflammation associated with ear infections

Vosol, Auralgan

Systemic Preparations

Refer to Chapter 17: Amoxicillin and Augmentin

 

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Otic (Ear) Medications (3 of 3)

Earwax buildup and blockage

Earwax (cerumen) in the canal can inhibit hearing and can cause pain

Most common in older adults

Debrox is an OTC that is used to soften and loosen excessive earwax

See Table 18-4

 

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Essentials of Pharmacology for Health Professions

Eighth Edition

Chapter 19

Analgesics, Sedatives, and Hypnotics

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Introduction (1 of 2)

Analgesics, sedatives, and hypnotics

Depress central nervous system (CNS) action to varying degrees

Some drugs can be classified into more than one category, depending on the dosage

Analgesics: relieve pain

Sedatives: calm, soothe, or produce sedation

Hypnotics: produce sleep

 

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Introduction (2 of 2)

The following slides discuss various analgesics, sedatives, and hypnotics

Refer to the chapter for specific side effects, precautions, contraindications, and interactions

 

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Analgesics (1 of 8)

Pain is the most common reason for patients to seek out medical care

Most common types: back, neck, migraine, and facial or jaw pain

Is subjective: can be experienced or perceived only by the individual subject. Pain scale: 1 to 10

Can be blocked by endorphins

Endogenous analgesics produced within the body as a reaction to severe pain or intense exercise

 

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Analgesics (2 of 8)

Opioid analgesics

Full or pure agonists, partial agonists, or mixed agonist-antagonists

Each bind to specific receptors with varying degrees of action

Classified as controlled substances

Potential for abuse and psychological dependence

Tolerance and physiological dependence

See Table 19-1

 

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Analgesics (3 of 8)

Opioid induced constipation (OIC)

Not-self limiting

Occurs because the digestive tract contains similar receptors (mu) that are targeted in pain relief, slowing the transit time

Most of the time, hydration, stool softeners or stimulant are effective

For severe OIC, prescription strength medication is required.

 

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Analgesics (4 of 8)

Tramadol (Ultram)

Centrally acting synthetic analog of codeine with a dual mechanism of action

Produces analgesia by weak inhibition of norepinephrine and serotonin reuptake; is an opioid receptor agonist

Less potential for abuse or respiratory depression (although both may occur)

 

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Analgesics (5 of 8)

Nonopioid analgesics

See Table 19-2

Many available without prescription as over-the-counter (OTC) medications

Given for relieving mild to moderate pain, fever, and anti-inflammatory conditions

Used as a coanalgesic in severe acute or chronic pain requiring opioids

 

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Analgesics (6 of 8)

Salicylates (aspirin) are most commonly used for their analgesic and antipyretic properties, as well as for their anti-inflammatory action

Acetaminophen has analgesic and antipyretic properties, but very little effect on inflammation. (major changes in Tylenol dosing)

Aspirin and acetaminophen are frequently combined with opioids or with other drugs for more effective analgesic action

Nonsteroidal anti-inflammatory drugs (NSAIDS) are discussed in Chapter 21

 

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Analgesics (7 of 8)

Adjuvant analgesics

May enhance analgesic effect with opioids and nonopioids, produce analgesia alone, or reduce side effects of analgesics

Treatment for nerve pain and fibromylagia

Tricyclic antidepressants

Treats fibromyalgia and nerve pain associated with herpes, arthritis, diabetes, and cancer, migraine or tension headaches, insomnia, and depression

Pain often described as “burning”

 

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Analgesics (8 of 8)

Anticonvulsants

Examples: Neurontin and Tegretol

Commonly used for management of nerve pain associated with neuralgia, herpes zoster (shingles), and cancer

Implemented when patient describes pain as “sharp,” “shooting,” “shock-like pain,” or “lightning-like”

See Table 19-3

 

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Local Anesthetic

Lidocaine patch (Lidoderm)

Approved for management of postherpetic neuralgia

Can provide significant analgesia in other forms of neuropathic pain

Diabetic neuropathy and musculoskeletal pain such as osteoarthritis and low back pain

Provides pain relief through a peripheral effect and generally has little, if any, central action

Must be applied to intact skin

 

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Antimigraine agents

Migraine is the most common neurovascular headache and may include nausea, vomiting, and sensitivity to light and noise.

Simple/opioid analgesics and NSAIDs are effective, especially if taken at initial sign of migraine

Serotonin receptor agonists (SRAs)

Action: serotonin levels decrease, while vasodilation and inflammation of blood vessels in brain increase as migraine symptoms worsen

Effective treatment for nausea and vomiting

See Table 19-4

 

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Sedatives and Hypnotics (1 of 2)

Medications used to promote sedation in smaller doses, and sleep in larger doses

Insomnia is one of the most prevalent sleep disorders

Antihistamines (Benadryl) and Barbiturates

Benzodiazepines (BZDs) and nonbenzodiazepines

Less abuse potential

Withdrawal effects are observed after long-term use and respiratory depression (when taken with alcohol) can be potentially fatal

 

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Sedatives and Hypnotics (2 of 2)

Melatonin receptor agonist

Ramelteon (Rozerem): first FDA-approved prescription medication that acts on melatonin receptor

Mimics action of melatonin to trigger sleep onset

Dependence and abuse potential are eliminated

Not classified as a controlled substance

Works quickly, generally inducing sleep in less than one hour

See Table 19-5

 

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Essentials of Pharmacology for Health Professions

Eighth Edition

Chapter 20

Psychotropic Medications, Alcohol, and Drug Abuse

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Introduction (1 of 2)

Psychotropic refers to any substance that acts on the mind

Psychotropic medications are drugs that can exert a therapeutic effect on a person’s mental processes, emotions, or behavior

Classified according to the purpose for administration: CNS stimulants, antidepressants, anxiolytics, antimanic, and antipsychotic medications

 

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Introduction (2 of 2)

The following slides discuss various psychotropic medications

Refer to the chapter for specific side effects, precautions or contraindications, and interactions

Drug and alcohol abuse is also discussed

Refer to the chapter for specific symptoms and treatment options

 

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CNS Stimulants (1 of 2)

CNS (central nervous system) stimulant medications

Given to promote CNS functioning

Caffeine

Helps fight fatigue and drowsiness

Examples: NoDoz, Vivarin, and caffeine citrate

Prolonged, high intake of caffeine in any form may produce tolerance, habituation, and psychological dependence

See Table 20-1

 

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CNS Stimulants (2 of 2)

Amphetamine/methylphenidate preparations

Controlled substances (Schedule II)

Treats attention-deficit hyperactivity disorder (ADHD) in children over age six and for narcolepsy

Examples: Adderall and Ritalin

Wakefulness-promoting agents

Provigil is a psychostimulant approved for narcolepsy, sleep apnea, and shift-work sleep disorder

 

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Selective Norepinephrine Reuptake Inhibitor (SNRI) for ADHD

Atomoxetine (Strattera)

Selective norepinephrine reuptake inhibitor

First nonstimulant, noncontrolled drug approved for attention-deficit hyperactivity disorder (ADHD)

Structurally related to fluoxetine

Does not have a potential for abuse, has less insomnia, less effect on growth, and has been shown to be safe and effective

 

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Antidepressants (1 of 5)

Major depressive disorder (MDD)

Caused by a chemical imbalance in the brain

Mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem and loss of interest or pleasure in normally enjoyable activities

Antidepressant medications, sometimes called mood elevators, are used primarily to treat patients with various types of depression

“Black box” warning

 

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Antidepressants (2 of 5)

Tricyclic antidepressants

Mechanism of action involves potentiation of norepinephrine and serotonin activity by blocking their reuptake

Monamine oxidase inhibitors (MAOIs)

Mechanism of action involves increasing concentrations of serotonin, norepinephrine, and dopamine in the neuronal synapse by inhibiting the MAO enzyme that degrades or breaks down these nuerotransmitters

 

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Antidepressants (3 of 5)

Selective serotonin reuptake inhibitors (SSRIs)

First-line medications for treatment of depression

Greater safety in the cases of overdose

Selectively block reabsorption of serotonin, helping to restore the brain’s chemical balance

Example: Prozac and Zoloft

 

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Antidepressants (4 of 5)

Selective norepinephrine reuptake inhibitors (SNRIs)

Inhibit reuptake of serotonin and norepinephrine

Affective in patients with chronic pain

Examples: Cymbalta and Effexor

 

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Antidepressants (5 of 5)

Heterocyclic antidepressants

Comparable efficacy to first-generation tricyclic antidepressants,

Differing effects on dopamine, norepinephrine, and serotonin

Distinctly different adverse effect profiles

Examples: Wellbutrin and Remeron

See Table 20-2

 

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Antimanic Agents

Bipolar disorder

Mental illness characterized by severe fluctuations in mood extremes

Patients may experience high (mania) and low (depression) mood swings with a diminished capacity for daily functioning

Lithium

Treatment of mania, lowered the suicide rate

Serum levels are checked to prevent toxicity

See Table 20-3

 

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Anxiolytics (1 of 2)

Anxiety becomes a disorder when it becomes excessive and difficult to control

Types of anxiety disorders

Social anxiety, post-traumatic stress disorder, panic attacks, and obsessive compulsive behavior

Benzodiazepines (BDZs)

For short-term treatment of anxiety disorders, some psychosomatic disorders and insomnia, and alcohol withdrawal

Examples: Valium, Klonopin, and Versed

 

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Anxiolytics (2 of 2)

Other anxiolytics

Buspirone (BuSpar)

Indicated for treatment of generalized anxiety disorder, but not other anxiety disorders (or depression)

Hydroxyzine (Vistaril)

Used IM as a pre- and postoperative antiemetic and sedative

See Table 20-4

 

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Antipsychotic Medications/Major Tranquilizers (1 of 3)

Also called neuroleptics

First and second generation agents

Useful in two major areas

Relieving symptoms of psychoses including delusion, hallucinations, agitation, and combativeness

Relieving nausea and vomiting

 

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Antipsychotic Medications/Major Tranquilizers (2 of 3)

Modify disturbed behavior and relieve severe anxiety without impairment of consciousness

Work primarily by blocking dopamine receptors

Results in unbalanced cholinergic activity

Causes frequent extrapyramidal side effects to include tardive dyskinesia

 

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Antipsychotic Medications/Major Tranquilizers (3 of 3)

Atypical antipsychotics

Block both serotonin and transiently block dopamine receptors

Less potential for adverse effects

There is no “ideal” antipsychotic medication

Both conventional and atypical antipsychotic medications are associated with significant adverse drug reactions

See Table 20-5

 

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Drug Abuse (1 of 2)

Drug abuse

The use of a drug for other than therapeutic purposes

Drug addiction

A combination of tolerance, psychological dependence, physical dependence, and withdrawal syndrome with physiological effects

 

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Drug Abuse (2 of 2)

Chemical dependency

A condition in which alcohol or drugs have taken control of an individual’s life and affect normal functioning

 

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Alcohol (1 of 2)

Ethyl alcohol, ethanol)

Classified as a psychotropic drug and a CNS depressant

Number one drug problem in the U.S.

Responsible for more than half of the traffic accidents in the U.S and most commonly abused drug among American teenagers

Fast acing depressant and rapid absorbed from the GI tract

Prolonged use can cause CNS damage

 

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Alcohol (2 of 2)

Alcohol poisoning

Symptoms include cold, clammy skin; stupor; slow, noisy respirations; and alcoholic breath

Mortality associated with acute alcohol poisoning alone is uncommon, but can be an important factor when mixed with recreational drugs

Treatment: Refer to chapter text for description

Chronic alcoholism

Refer to chapter text for symptoms and treatment options

 

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Prescription Drug Abuse

Nation’s fastest growing drug problem

Second most-abused category of drugs after marijuana

According to the CDC, death rates from opioid overdoses have more than tripled since 1999

Proper disposal and storage is important for deterring abuse

Most often abused by medical professionals are fentanyl, oxycodone, hydrocodone and BDZ’s

 

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Illegal Drug Abuse (1 of 7)

Amphetamines

Examples: methamphetamine (“crystal,” “crank,” “ice,” “meth,” “speed”) and methylenedioxymethamphetamine (MDMA, “Ecstasy”)

Abrupt withdrawal may unmask mental problems

 

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Illegal Drug Abuse (2 of 7)

Marijuana

Active ingredient: tetrahydrocannabinol (THC)

CNS depressant, euphoriant, sedative, and hallucinogen

Marinol is approved for the prevention of chemotherapy-induced nausea and vomiting

Synthetic cannabinoids

“Spice”, “K2”, “skunk”, fake weed: shredded plant material and chemical additives

 

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Illegal Drug Abuse (3 of 7)

Cocaine

Highly addictive CNS stimulant

Produces euphoria and increased expenditure of energy

Hallucinogens

Produce bizarre mental reactions and distortion of physical senses

Examples: lysergic acid (LSD) and phencyclidine (PCP)

 

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Illegal Drug Abuse (4 of 7)

Dextromethorphan (DXM)

Semisynthetic morphine derivative

Safe, effective, nonaddictive, OTC cough suppressant when used appropriately

Often abused by teens because of its phencyclidine-like euphoric effect

 

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Illegal Drug Abuse (5 of 7)

Flunitrazepam (Rohypnol)

Potent benzodiazepine approved for use in Central and South America for ethanol withdrawal

Known on the street as “roofies” and the “date-rape drug”

 

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Illegal Drug Abuse (6 of 7)

Role of the medical personnel

Have a thorough knowledge of psychotropic drugs, action, and side effects

Be willing to participate in the education of the patient, patient’s family, and others

Give competent care to those under the influence of drugs in a nonjudgmental way

Recognize drug abuse and make appropriate referrals without exception

 

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Illegal Drug Abuse (7 of 7)

Role of the medical personnel

Keep complete and accurate records of controlled stocks of drugs that could be considered potential drugs of abuse

Report any observed drug abuse to the proper person in authority

 

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Essentials of Pharmacology for Health Professions

Eighth Edition

Chapter 21

Musculoskeletal and Anti-Inflammatory Drugs

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114

Introduction

Disorders of the musculoskeletal system are rather common

Drugs used to treat such conditions are classified in two broad categories

Skeletal muscle relaxants

Nonsteroidal anti-inflammatory drugs (NSAIDs)

The following slides discuss various musculoskeletal and anti-inflammatory drugs

Refer to the chapter for side effects, precautions or contraindications, and interactions

 

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Skeletal Muscle Relaxants (1 of 2)

Many disorders associated with pain, spasm, abnormal contraction, or impaired mobility respond to skeletal muscle relaxants

Given only on a short-term basis

Most affect the central nervous system

No direct effect on skeletal muscle

Reduces muscle spasm, causes alterations in the perception of pain, and produces a sedative effect, promoting rest and relaxation

 

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Skeletal Muscle Relaxants (2 of 2)

Neuromuscular blocking agents (NMBAs)

Cause a direct effect on the muscles including the diaphragm

Used during surgical, endoscopic, or orthopedic procedures

Potentially very dangerous

Can result in respiratory arrest because of the potential to paralyze the diaphragm

See Table 21-1

 

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Anti-Inflammatory Drugs (1 of 4)

Treat disorders in which the musculoskeletal system is not functioning properly due to inflammation

Examples: arthritis, bursitis, spondylitis, gout, and muscle strains and sprains

Nonsteroidal anti-inflammatory drugs (NSAIDS)

Frequently given for lengthy time periods in maintenance doses as low as possible for effectiveness

 

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Anti-Inflammatory Drugs (2 of 4)

NSAIDs, such as ibuprofen, inhibit synthesis of prostaglandins

Substances responsible for producing much of the inflammation and pain of rheumatic conditions, sprains, and menstrual cramps

No cure has been found for rheumatic disorders, but many medications are used to alleviate pain

Salicylates (e.g., aspirin) are the oldest drug in this category with analgesic, anti-inflammatory, and antipyretic effects

 

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Anti-Inflammatory Drugs (3 of 4)

FDA warning regarding over-the-counter (OTC) nonselective NSAIDs

Should be used in strict accordance with label directions

Self-treatment should not exceed ten days, unless directed by a physician

 

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Anti-Inflammatory Drugs (4 of 4)

COX-2 inhibitor

Celecoxib (Celebrex): NSAID that exhibits anti-inflammatory, analgesic, and antipyretic activities

Selectively inhibits cyclooxygenase-2 (COX-2) prostaglandin synthesis, does not inhibit COX-1

Does not inhibit platelet aggregation (clotting) or inhibit production of mucosal-protective prostaglandins

Increases the risk of a cardiac event

See Table 21-2

 

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Osteoporosis Therapy (1 of 7)

Osteoporosis

A systemic skeletal disease

Characterized by low bone mass and deterioration of bone tissue, leading to bone fragility and increased susceptibility to fracture, especially of the hip, spine, and wrist

Most commonly affects postmenopausal women

Diagnosis: measure bone mineral density

Therapy includes calcium, vitamin D, and prescription medications

 

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Osteoporosis Therapy (2 of 7)

Bisphosphonates

Nonhormonal agents

Act directly to inhibit bone reabsorption, increasing bone mineral density at the spine and hip, and decreasing incidence of first and future fracture

Bind strongly to and accumulate in bone, creating a reservoir of drug that is released back into systemic circulation gradually over a period of months or years after treatment is stopped

Examples: Fosamax and Reclast

 

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Osteoporosis Therapy (3 of 7)

Hormones involved in osteoporosis therapy

Estrogen before menopause helps to maintain a normal bone reabsorption rate in women

Hormone replacement therapy (HRT), estrogen with or without progestin, is recommended for postmenopausal osteoporosis prevention only when unable to take other agents, and when benefits outweigh risks

 

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Osteoporosis Therapy (4 of 7)

Selective estrogen-receptor modifiers (SERMs)

Raloxifene (Evista) is a selective estrogen receptor modifier with estrogen agonist activity on bone and lipids and estrogen antagonist activity on breast and uterine tissue

Increase bone mineral density, decrease bone reabsorption, and reduce fracture risk without promoting breast or endometrial cancer

 

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Osteoporosis Therapy (5 of 7)

Calcitonin-salmon

Synthetic form of the hormone calcitonin is available as a nasal spray (Miacalcin) or as a subcutaneous injection

Involves with calcium regulation, increases spinal bone density, and provides an analgesic effect in acute vertebral fractures

Reserved for women who refuse or cannot tolerate HRT or in whom HRT is contraindicated

 

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Osteoporosis Therapy (6 of 7)

Parathyroid hormone

Teriparatide (Forteo) is an injectable form of parathyroid hormone approved for postmenopausal women and men with osteoporosis at a high risk for having a fracture

Increases GI calcium absorption and renal tubular reabsorption of calcium, increasing bone mineral density, bone mass, and strength

 

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Osteoporosis Therapy (7 of 7)

Monoclonal antibodies

Prolia: inhibits osteoclast activity

Reserved for patients with a higher risk of fracture

Subcutaneous injection given bi-annually

See Table 21-3

 

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