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Medications

Medications. A Pharmacist’s perspective. Medications. Medications. Ying and The Yang. Medications. Does the benefit outweigh the risk Is this the right medication for the right person Ibuprofen for a pt with GI problems Is the person benefiting from the med as a whole

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Medications

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  1. Medications A Pharmacist’s perspective

  2. Medications

  3. Medications

  4. Ying and The Yang

  5. Medications • Does the benefit outweigh the risk • Is this the right medication for the right person • Ibuprofen for a pt with GI problems • Is the person benefiting from the med as a whole • Pt was taking isosorbide mononitrate – stopped taking and was able to walk without cane again

  6. Medications • A Drug broadly defined as any chemical agent that affects a living protoplasm • May alter the body by many different processes • Increase / decrease normal chemical absorption • Influence body systems

  7. Pharmacokinetics • Absorption, distribution, metabolism, and excretion

  8. Absorption • Describes the rate at which the drug leaves the site of administration and the extent to which this occurs • Bioavailability – the fractional extent to which a dose of drug reaches its site of action

  9. Distribution • Drug distributes into the interstitial and intracellular fluids • Lipophilic • Extent of protein binding

  10. Metabolism • Liver Enzymes • Metabolize medications to active components

  11. excretion • Renal excretion • Some meds affect the kidneys (renal adjusting) • Some meds are reabsorbed

  12. Half-life • Time in which one-half of the medication is remaining • Important for understanding length of effectiveness • Length of Side effects • Length of time till therapeutic dose is reached

  13. recepter

  14. Drug characteristics • PH • Cholenergic effects • Anticholenergic effects • Slug

  15. resources • Micromedex • Drug facts and comparisons • Pubmed • Internet • Rxlist.com • Drugindex.com

  16. Stroke • A stroke is the sudden death of brain cells in a localized area due to inadequate blood flow • A stroke may be caused by a blocked artery (ischemic stroke) or a leaking or burst blood vessel (hemorrhagic stroke). Some people may experience a temporary disruption of blood flow through their brain (transient ischemic attack

  17. Stroke • Transient ischemic attack (TIA)A transient ischemic attack (TIA) — also called a ministroke — is a brief episode of symptoms similar to those you'd have in a stroke. A transient ischemic attack is caused by a temporary decrease in blood supply to part of your brain. TIAs often last less than five minutes.

  18. Stroke • Ischemic stroke • 85% percent of strokes • arteries to your brain become narrowed or blocked • Thrombotic stroke. • occurs when a blood clot (thrombus) forms in one of the arteries that supply blood to your brain. • Embolic stroke • occurs when a blood clot or other debris forms away from your brain and is swept through your bloodstream to lodge in narrower brain arteries

  19. Stroke • Hemorrhagic stroke • occurs when a blood vessel in your brain leaks or ruptures. • Intracerebral hemorrhage. • a blood vessel in the brain bursts and spills into the surrounding brain tissue • Subarachnoid hemorrhage • an artery on or near the surface of your brain bursts and spills into the space between the surface of your brain and your skull. This bleeding is often signaled by a sudden, • caused by the rupture of an aneurysm, a small sack-shaped or berry-shaped outpouching on an artery in the brain

  20. Stroke • LONG TERM PREVENTION OF ISCHEMIC STROKE • Anticoagulants • Warfarin • Heparin • Lovenox • Pradexa • Xarelto • Antiplatelets • Aspirin • Clopidogrel • Aggrenox • Effeint

  21. Stroke • Anticoagulants • Heparin- bind to antithombin and accelerate effects • Effects diminish after hours of discontinuation • Bleeding is biggest set back • Warfarin- Vit K antagonist- coagulation cascade • Measured by INR (international normalized ratio) • Metabolized by enzyme P450 – other drugs may compete and INR may rise or fall

  22. Stroke • Antiplatelets • Aspirin – irreversible inhibition of platelets’ ability to synthesize proteins needed for recruitment and activation. • Clopidogrel and Ticlid - irreversible inhibition of platelets’ ability to synthesize proteins needed for recruitment and activation. • Aggrenox (dipyridamole/aspirin) • Effient

  23. Gastroesophageal reflux diseaseGERD Is the movement of gastric contents of the stomach to the esophagus

  24. GERD • Causes inflammation and may lead to erosion

  25. GERD • Medications that decrease lower esophageal sphincter pressure • Nicotine, diazepam, progesterone, morphine, anticholenergics, caffeine

  26. GERD • Medications that are direct irritants to esophageal mucosa • Fosamax, aspirin, iron, NSAIDS, KCL

  27. GERD • Medications used to treat GERD • H2 Receptor antagonist • Zantac, pepsid, tagement • Antacids • TUMs (calcium), aluminum • Maalox • Proton pump inhibitors • Prilosec, protonix, aciphex, nexium, prevacid

  28. GERD • H2 receptor antagonist • Not as potent as PPI • Suppress 24 hour gastric secretion by 70% • May alter rate of absorption of other drugs • Cimetidine may increase levels of other drugs

  29. Proton pump inhibitors • Decrease production of acid by 80-95 % • All are equivalent at comparable doses • Usually must be on this drug for 2-5 days before steady state is reached • SE – headache, nausea • Prilosec may reduce effects of clopidagrel • Chronic use has been linked to bone fractures

  30. Medications common to TBI and stroke recovery patients • Seizure • Platelet Inhibitors • Agitation • Sleep • Anxiety • Memory • Parkinson and Parkinson like syndrome • Antiemetic

  31. Antiepileptic • Epilepsy – derived from greek word epilepsia meaning “to come upon, to be grabbed hold of or thrown down attack , to seize hold of” • As been recognized for 2400 years • Defined as small number of neurons discharging abnormally

  32. Antiepileptic • Mechanism of action of most AEDs • Affect ion channels • Augmenting inhibitory transmission • Or modulating excitatory transmission

  33. Antiepileptic

  34. Antiepileptic Common medications Less common Medications • Benzodiazepines • Phenobarbital • Carbamazepine • Gabapentin • Lyrica • Dilantin • Ethosuuxamide • Valproic Acid • Lamotrigine • Keppra • Zonisamide • Banzel • Vimpat

  35. Antiepileptic • Adverse reactions • Keppra – somnolence (sleepiness), asthenia(weakness), and dizziness • Lamotrigine – dizziness, ataxia 9 defective muscle coordination), blurred or double vision, n&v • Gabapentin – somnolence, dizziness, ataxia, and fatigue • Benzos – Increased salivary and bronchial secreations, drowsiness, and lethergy.

  36. Insomnia • Ambien • Sonata • Lunesta • Trazodone • Seroquel • Rozerem • Ativan • Mirtazapine

  37. Insomnia • Ambien • Comparable to benzodiazapines • No significant effects on next day psychomotor performance • No tolerance

  38. Insomnia • Antidepressents • Amitriptyline • Mirtazapine • Trazodone • Doxapin • H1 receptor antagonist contributes

  39. Insomnia • Adverse effects • Groggy (antidepressants) • Sleep walking • Potential for dependence

  40. Agitation • Antipsychotics • Antidepressants

  41. Agitation • Antipsychotics • Work on receptors for serotonin and dopamine • 2 types atypicals and typicals • Biggest difference is SE – affects on dopamine

  42. Agitation Atypical Psychotics Typical Psychotics • Zyprexa • Seroquel • Geodon • Abilify • Risperdal • Clozaril Haldol Chlorpromazine

  43. Agitation • Adverse affects • Acute dystonia • Akathsia • Parkensonism • Tardive dyskinesia

  44. Antidepressants • SSRIs (serotonin reuptake inhibitors) • SNRIs (serotonin/norepinepherine reuptake inhibitors) • Tricyclic

  45. Antidepressants • SSRIs • Fluoxetine • Sertraline • Paroxatine • Lexapro • Celexa • May cause dullness of intellectual abilities and concentration, insomnia, irritabilty, and decreased libido

  46. Antidepressants • Tricyclic • Imipramine • Amitriptyline • Trazodone • Desipramine • Doxapin • Work on NE and SSRI • Can prolong QT interval • Block Histamine – causing sedation • Narrow therapeutic window

  47. Antideppresents • SNRIs • Effexor

  48. Medications to Stimulate appetite • Megace (Megestrol Acetate) • synthetic progestogen which differs structurally from progesterone • Used for endometrial carcinoma and breast cancer • Biggest side effect is appetite increase

  49. Medications to Stimulate appetite • Oxandrolone • a synthetic derivative of testosterone • Indicated as adjunctive therapy to promote weight gain in patients who have lost weight as a result of chronic infection, surgery, or severe trauma. Also for use to offset protein catabolism after prolonged corticosteroid use, and in patients who fail to gain or maintain weight without definite pathophysiologic reasons

  50. Medications to Stimulate appetite • Marinol • Dose-related reversible effects on appetite, mood, cognition, memory, and perception • Cyproheptadine • a serotonin and histamine antagonist that competes with serotonin and histamine respectively, for receptor sites. It has also anticholinergic and sedative effects

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