Movies, Pharmacology

Medications with Better Living Through Chemistry


Amoxicillin 

  • Antibiotic/Antimicrobial/Antibacterial
  • treats infections

Amoxicillin (plus Clarithromycin and protonpump inhibitor such as Omeprazol ([Prilosc]) 

  • given with pneumonia patients who has existing cardio pulmonary disease
  • high dose of amoxicillin/Clavulanate ([Augmentin, Clavulin]) plus a macrolide or doxycycline
  • a bacterial antibiotic that assists with eradicating H-Pylori bacteria in the gastric mucosa
  •  may cause diarrhea
  •  do not use in patients allergic to penicillin

Amoxicillin / Amoxil

  • first line of antibiotic for acute sinusitis

Clavulanate/Augmentin 

  • second line of antibiotic for acute sinusitis

Amoxicilliry/Clavinate (Augmentin) 

  • antimicrobial agents

Antideppressants

Sertraline/Zoloft

T-1/2 = 24 hours

Dosage: 50-200 mg/dc

Use: Depression, Panic Disorder, OCD, PTSD, Social Anxiety Disorder, PMDD

Side Effects: Drowsiness, dizziness, headache,fatigue,insomia,nausea,diarrhea, dry mouth, sexual dysfunctioning, sweating, tremor, myalgia, anxiety, altered taste, hot flashes, etc. 

Caution:Hepatic/ Renal Impairment/Pregnancy/Lactation/ Children

Serious Fatal Reaction with MAOI’s: concurrent primozide; do not use with St. John’s wort or SAMe; drug-drug interactions with drugs that inhibit the P-450 system. 

MAOI Diet (Tyramine) Restrictions

Foods must avoid completely

  • Aged red wines (cabernet sauvignon/merlot/Chianti)
  • Aged (smoked, aged, pickled, fermented, marinated, and processed) meats (pepperoni/bologna/salami, pickled herring, liver, frankfurters, bacon, ham)
  • Aged/mature cheeses (blue/cheddar/provolone/Brie/Romano/Parmesan/Swiss)
  • Overripe fruits and vegetables (overripe bananas/ sauerkraut/all overripe fruit)
  • Beans (fava/Italian/Chinese pea pod/fermented bean curd/soya sauce/miso soup)
  • Condiments (bouillon cubes/meat tenderizers/canned soups/gravy/sauces/soy sauce)
  • Soups (prepared/canned/frozen)
  • Beverages (beer/ales/vermouth/whiskey/liqueurs/canned soups/gravy/sauces/soy sauce)

Foods use with caution moderation

  • Avocados (not overripe)
  • Raspberries (small amounts)
  • Chocolate (small amounts)
  • Caffeine (2-8 oz. Servings per day or less)
  • Dairy products (limit to buttermilk, yogurt, and sour cream [small amounts]; cream cheese, cottage cheese, milk ok if fresh)

Medications: Must Avoid

  • stimulants and decongestants
  • OTC medications (check with PCP/pharmacist) 
  • Opioids (e.g. meperidine)

Biguanides

Metformin (Glucophage)

  • oral antidiabetic agents
  • produces it’s antidiabetic effects by facilitating insulin’s action on peripheral receptor sites
  • it can be used only in the process of insulin
  • have no effect on pancreatic beta cells
  • used with a sulfonyl urea 
  • may enhance the glucose -lowering effect more than either medications used alone.

Complication: Lactic Acidosis (Monitor closely when therapy is initiated/dosage change

Drug Interactions: 

  • Anticoagulants
  • Corticosteroids
  • Diuretics
  • Oral Contraceptives 

Contraindications

  • renal impairment serum creatinine level more than 1.4
  • risk for renal dysfunction (e.g. Acute Myocardial  Infarction

Renal function studies performed periodically to ensure that function is not impaired. 

Withold for two days prior to diagnostic testing that requires contrast agent. Increase risk for lactic acidosis. An extended release form and a combination form (Glucovance) combines Metformin with a Sulfonylurea such as glyburide. The combination provides two mechanism of action and improved potential compliance. Hypoglycemia is at risk.

Anticonvulsants

Carbamazepine (CBZ) / Tegretol

T1/2 = initial: 18-55 h;

long-term 

dosing: 12-17 h 

Dosage: 400-1200 mg/d (mania)

Use: Bipolar: Acute Mania; mixed; seizures, trigeminal pain

Common Side Effects: Ataxia, drowsiness, blurred vision, APLASTIC ANEMIA, AGRANULOCYTOSIS, THROMBOCYTOPENIA, STEVENS-JOHNSON SYNDROME (SJS) 

CAUTION : Therapeutic Range (4-12ug/mL) Weekly CBC, platelet and reticulocyte counts, LFTs; impaired renal/liver/cardiac functions. Sx of SJS: cough, FUO, mucosal lesions, rash; stop CBZ.

Chantix/ Varenicline

– treats nicotine addiction

Side Effects: Constipation give enema as prescribe 


Antiviral Drug

Valtrex (Valacyclovir)

Treatment: herpes virus, genital herpes, cold sores, shingles

Side effects: nausea, vomiting, diarrhea and headache

Opiods:

Oxycodone

orally- provides a consistent serum level than IM

Dosage: 20 to 30 mg 

T1/2: 2-3 hours

Duration 2-4 hours

Side effects:

  • Respiratory deppression – increase risk with age and with other depressants
  • sedation- opioid doses are increase; increase the time of dose and reduce dose temporarily as prescribe
  • Nausea and vomiting – appears after a few hours of ingestion; change position slowly; hydrate and give antiemetic drugs as prescribe
  • Constipation – mild laxative; fluid; fiber; 
  • Check for liver toxicity

 Antianxiety (Anxiolytic drugs)

Benzodiazepines

Alprazolam/ Xanax

Use: Anxiety, panic disorde

Dosage: 0.75-4 mg/d; not to exceed 10 mg/d

Common Side effects: Dizziness, drowsiness, lethargy, headahe, blurred vision, constipation, diarrhea. Possible physical/psychological dependence,tolerance, paradoxical excitation

Caution:  Hepatic dysfunction

Contraindications: pregnancy/lactation; narrow-angle glaucoma; concurrent ketoconazole or itraconazole; decrease dose elderly/debilitated

Attention Deficit Hyperdisorder (ADHD) 

Amphetamine/ Adderall 

Dosage: 5-40 mg/ 10-30 mg

Use: focus

Cardiovascular Drugs

Angiotensin Converting Enzyme Inhibitors

Benazepril (Lotensin)/Captopril (Capoten)

  • Inhibits conversion of angiotensin I to angiotensin Ii
  • Lowers total peripheral resistance
  • Fewer cardiovascular side effects
  • Can be used with thiazide diuretics and digitalis
  • Hypotension can be reversed by fluid replacement
  • Contraindicated with renal impairment/pregnancy
  • Gerontologic considerations: requires reduce dosage and the addition of loop diuretics when there is a renal dysfunction


Angiotensin II Receptor Blockers

Losartan (Cozaar)/Eprosartan (Teveten)

  • Block the effects of angiotensin II at the receptor
  • Treats hypertension
  • Reduce peripheral resistance
  • Minimal side effects
  • Contraindicated: pregnancy, renovascular disease
  • Monitor for hypokalemia


Antilipidemics

Lipitor (Atorvastatin)

Dose: Given once daily, usually in the evening

  • Statins inhibit an enzyme involved in cholesterol synthesis, especially in the liver.
  • Increase serum high density lipid (HDL)
  • Decrease low density lipid (LDL)  and very low density lipid (VLDL) and plasma + triglyceride levels
  • Nursing implications: contraindicated to pregnancy
  • May cause multiple gi symptoms
  • Increased liver function test
  • Increased digoxin and oal contraceptive levels
  • May cause rhabdomyolysis
  • Discontinue at first sign of pain


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    Herbal Medicine

    10 Herbal Medicine with Muro Ami

     

    The ship will sail again, and their main goal was to survive and bring a better future for their family. Fredo has lead the children and adult reef hunters for several years and has thought them to be strong and disciplined. Despite of his condition he will continue to struggle with the sea until he achieve his dream for himself and for everyone.

    Fredo seeks the treatment of a traditional healer called the “albularyo” with a natural herbs patched on his back.


    Ten Herbal Medicine in the Philippines recommended by the DOH

    1. Lagundi (Vitrex Negundo)

    Preparation for asthma, cough, dysentery, colds, pain and influenza

    • Select leaves that are in bloom and ripe fruits.
    • Boil them together with two glasses of water for 15 minutes or until the water dissolves into a glass of decoction.
    • Strain and give a dosage of 4 tbsp with dried leaves and  6 tbsp with fresh leaves for adults.

    Preparation for skin diseases (dermatitis, eczema, scabies, ulcer and dermatitis:

    •  Apply the decoction on the affected part.

    Preparation for pain (headache, rheumatism, sprain, contusions and insect bites):

    •  Crush or pound the leaves and patched it directly on the part with pain.
    •   Add the crushed leaves in a warm water for bathing.
    Philippine Herbal Medicine Yerba Buena

     

    2.   Yerba Buena, Hierba Buena (Mentha Cordifelia)

    •    For pain (headache, stomach ache, rheumatism, and arthritis) or pruritus follow the same prepation for decoction or apply the pounded leaves with eucalyptus directly on to the affected parts.
    •     Tea preparation as an expectorant for cough and colds and a relief for menstrual and gastric pain. Boil ten leaves with a glass of water then serve.
    •      Used as a mouthwash for swollen gums.
    •      A pain reliever for toothache after rinsing with 5 grams of salt with warm glass of water. Squueze the plant and gather the sap with a cotton and place it on the tooth.
    •      Make a scent for nausea and fainting by grinding the leaves and putting it on fromt of the nose or use it as a paste for insect bites.
    Medicinal Health Guide Sambong

     

    3.      Sambong (Blumea balsamifera)

    •      Same decoction preparation and dosage for adults with edema, urolithiasis and urinary retention given three times a day.
    pinoy herbal medicine tsaang gubat

     

    4.     Tsaang Gubat (Carmona retusa)

    •      Same decoction for adult patients with diarrhea and stomach ache. Give 10 tbsp in dried leaves and 12 tbsp in fresh leaves. Drink four times every three hours
    Medical Health Guide Niyog Niyogan

     

    5.     Niyog – niyogan (Quisqualis Indican L.)

    •      The seeds are given for patients who needs to eliminate round worms from their digestive system. Doasage given to adults are 8-10 seeds 2 hours after meals. Contraindicated for childrens 4 years old and below.
    Wikipedia Guava

     

    6.      Bayabas/ Guava (Psidium guajava L.)

    •       The decoction of bayabas or guavas may be use to relieve toothache, diarrhea or wounds


    7.      Akapulko (Cassia, alata L)

    •        Use as a soap after crusing the leaves for ringworm, tinea flava, fungi, athletes foot and scabies
    Medical Health Guide

     

    8.      Ulasimang-Bato (Peperonia pellucida)/ Pansit pansitan

    •         Make decoction to decrease uric acid in gouthy arthritis or rheumatism.
    Bawang Garlic

     

    9.       Bawang

    •          Grinded garlic can treat toothache by placing it to the aching tooth.
    •           Relieves hypertension if eaten with meals or after meals, after roasting or cooked with water 30 minutes.


    10.      Ampalaya

    •            Decoction can treat by lowering the blood sugar levels in diabetes mellitus.

    References
    1. Public health nursing in the Philippines. [Manila]: National League of Philippine Government Nurses; 2007.

    Movies, Opiods

    Shallow Hal

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    Morphine Sulfate

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    Doctor: Mrs. Larson.
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    Doctor: He won’t be much longer Mrs. Larson
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    Mrs. Larson: Is he in a lot of pain?

     

     

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    Doctor: No, no, no. There will be no more pain for your husband. He’s heavily sedated.
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    Mrs. Larson: Ok, I think I’m gonna go send in Hal now
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    Doctor: No, no. I don’t think it’s such a good idea, with all the pain killers the reverent is not exactly himself.
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    Mrs. Larson: I think the boy has the right to say goodbye to his father.
    image
    Doctor: Well, your call.

    image

    Hal (Jack Black) bids farewell to his father who’s heavily sedated and hallucinating due to the side effect of Morphine.

    Morphine is narcotic or better known as an opiod drug that works by binding with opiod receptors and inhibit the transmission of severe pain. Morphine also acts to relieve anxiety by sedating the patient.

    It treats acute pain.

    1. Pulmonary edema (Congestive Heart Failure)
    • Morphine decreases peripheral resistance
    • decrease venus return
    • blood in the lungs tranfer to other parts of the body
    • which decreases pressure in capillary arteries
    • resulting in decrease pain and decrease anxiety

    2.  Myocardial Infarction

    • Reduces preload
    • decrease workload of the heart
    • relaxes bronchioles to enhance exit
    • decrease pain and anxiety
    • note for: st segment

    3.  Burn

    • It is the analgesic of choice in treating acute burn pain.

    It treats chronic pain.

    1. Cancer
    2. Neuropathic Disease
    3. Degerative Disease

    Patients who are allergic to morphine may experience itching or pruritus and may be given an antihistamine and a different pain reliever as prescribed.

    Vital signs should be monitored especially their respiratory rate for RESPIRATORY DEPPRESSION.

    And although morphine does not cause myocardial deppression it affects the circulatory system and can lead to hypotension.

    Naloxone hydroxide (Narcan) should be prepared at the bedside to reverse the side effect of morphine.

    Morphine decreases the gastrointestinal motility which causes constipation, nausea and vomiting. Laxatives  and fiber rich foods are given to the patient.

    Morphine is contraindicated in patients with respiratory disease, central nervous system disorder and kidney disorders.

    Long term use of morphine may lead to drug dependence (there is an evidence of pinpoint constricted pupils, euphoria and impaired judgment) and the doctor changes to a different opiod before they put a stop to giving pain reliever. Note if the patient is experiencing withdrawal symptoms such as dilated pupils, diaphoresis, sneezing and watery eyes.

     

     

     

     

     

     

    Herbal Medicine, Moorim school, Series

    Tiger Plant from Moorim School

    Tiger Lily, a bright colored perennial lily native to Asia. It is a common wildflower in the eastern United States. Tiger lilies, of which there are many varieties, are also cultivated in flower gardens. The plant grows four to six feet (1.2 to 1.8 m) in height. It has numerous lance-shaped leaves and long, reddish-orange, curved petals that are covered with purplish-black spots. The tiger lily is Lilium Tigrinum of the lily family, Liliaceae.

    Source: New standard encyclopedia

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