NUR 2407 PHARM FINAL EXAM 2 STUDY GUIDE
Week 4 – Chapter 37-39, 32-33
Chapter 37: Antineoplastic Agents
Cancer
• Cancer (malignant, neoplastic) cells are characterized by unregulated growth, lack
of differentiation and spread (metastasis) to other places in the body.
Anticancer Therapy:
• Chemotherapy is the use of chemicals to kill cancer cells by inhibiting or
preventing cell reproduction.
Classes of Chemotherapy Drugs:
- Alkylating Agents
- Antimetabolites
- Antitumor Agents
- Mitotic Inhibitors
- Hormonal Agents
Antimetabolites
Folic Acid Antagonist
- Methotrexate (Trexall) – Used to treat cancer, rheumatoid arthritis, psoriasis. INDUCES
MISCARRIAGES in patients with ectopic pregnancy.
General side effects: Bone suppression leading to leukopenia, thrombocytopenia, and
anemia. Can cause stomatitis, vomiting, alopecia, and hepatic/renal dysfunction.
Patients should report any signs of bleeding and have platelet levels checked.
Alkylating Drugs
Nitrogen Mustard
- Cyclophosphamide (Cytoxan) is used to treat Hodgkin’s disease and many other types of
cancer.
- This drug can cause hemorrhagic cystitis as result of severe bladder inflammation
- This drug should be taken with copious amounts of water and early in the day, so it does
not accumulate in the bladder.
Chapter 38: Targeted Therapies to treat cancer
Targeted Therapy:
, - Drugs or other substances that block the growth and spread of cancer by interfering with
specific molecules in tumor growth and progression.
- Cancers that do not have sufficient quantities of the specific molecular target will not
respond to targeted therapy.
Chapter 39: Biological Response Modifiers
Colony Stimulating Factors:
- Erythropoietin (Epoetin Alpha) stimulates red blood cell production, and increases
the risk of death when a patient’s hemoglobin is >12
Chapter 32: Anti-TB, Antifungal, Peptides, Metronidazole
Tuberculosis is caused by a bacterium call mycobacterium tuberculosis. The bacteria usually
attack the lungs, but TB bacteria can attack any part of the body, such as the kidney, spin, and
brain. If not treated properly, TB disease can be fatal.
- TB is one of the world’s top health challenges: More than 2 billion people, equal to a
QUARTER of the world’s population are infected with TB.
- Each year there is 9 million new cases and 1.5 million deaths
- Each day there is 24,000 new cases, 4000 deaths and 8,000 missed.
Latent TB Infection – TB bacteria can live in the body without making you sick. This is called
Latent TB Infection. In most people who breathe in TB bacteria and become infected, the body
is able to fight the bacteria to stop them from growing. People with this condition do no not feel
sick and do not have any symptoms. People with this condition are not infectious and cannot
spread TB bacteria to others.
TB Disease – TB bacteria becomes active if the immune system can’t stop them from growing.
When TB bacteria are active, multiplying in your body, this is called TB disease. People with
TB disease are sick. They may also be able to spread the bacteria to people they spend time
with every day.
- Mycobacterium have a thick, way cell wall. It is very tough!
Main Symptoms of Pulmonary Tuberculosis:
- Appetite Loss
- Fatigue
- Chest Pain
- Coughing up blood
- Productive, prolonged cough
- Night sweats, pallor
Anti- Tuberculars
TB Treatment
,- To prevent drug resistance – Multidrug Therapy (The golden standard of
treatment)
- Drugs: Isoniazid, Rifampin, Ethambutol, and Pyrazinamide*******
Rifampin
- Antimycobacterial
- Must be taken daily for several months with no break.
- Can stain body fluids orange.
- Can cause hepatotoxicity
- Take on empty stomach or absorption reduced by >30%***
- First discovered in soil from the French Riviera
Isoniazid
- Antimycobacterial
- BLACK BOX WARNING: Hepatoxicity
- Drug to Drug Interactions: Acetaminophen due to increased risk of liver damage***
- Drug of choice for pregnant women with TB
- Treats Latent and Active TB
- Can cause peripheral neuropathy in patients with vitamin B6 deficiencies
- First tested in the Navajo community Many Farms, AZ
Ethambutol
- Can cause vision problems, including optic neuritis and red green color blindness.
- Ok to take while breast feeding
- Antimycobacterial
Pyrazinamide
- Give in first months of combo therapy to reduce the total length of treatment (by
months)******
- Can cause arthralgia (joint pain), peripheral neuropathy, and hepatoxicity ***
-
Drug Resistance TB
- TB drug resistance is a major public health problem that threatens progress made in TB
care and control worldwide. This improper use is a result of a number of actions
including, administration of improper treatment regimens and failure to ensure that
patients complete the whole course of treatment.
- Extensively drug-resistant TB. MDR TB is caused by an organism that is resistant to at
least isoniazid and rifampin, the two most potent TB drugs.
- “Totally Drug-Resistant” tuberculosis: a WHO consultation on the diagnostic
definition and treatment options.
TB Vaccine
, - The Bacille Calmette-Guerin (BCG) vaccine has existed for 80 years and is one of the
most widely used of all currect vaccines, reading >80% of neonates and infants in
countries where it is part of the national childhood immunization programmer. BCG
vaccine has a documented protective effect against meningitis and disseminated TB in
children.
- The World Health Organization recommends that in countries with a high rate of TB
burden all infants should receive one dose of BCG attenuated live vaccine, as soon as
possible after birth.
Antifungal Drugs
Fungal Infections
- Can be topical or systematic
- Can be opportunistic or non-opportunistic
- Can be mild to life-threatening
- Can be caused by antibiotic or steroid use
- In the mouth, it is called Thrush***
Nystatin (Myostatin)
- Antifungal Drug
- Action: Binds to fungal cell membranes, causing cell contents to leak out = death
- Use: Topical treatment of fungal infections. Not absorbed in the GI system, so safe to
give orally.
- Elizabeth Lee Hazen and Rachel Fuller Brown discovered nystatin
- Swish and Swallow!!
Fluconazole (Diflucan)
- Antifungal Drug
- Used to treat candida infections and cryptocoal meningitis
- Pregnancy Category C, give with caution
Peptide Antibiotics
Bacitracin
- Effective against gram positive and some gram-negative bacteria
- Available OTC as ointment for application to the skin
- Peptide Antibiotic
Metronidazole
Metronidazole (Flagyl)
- Impairs DNA function of susceptible bacteria
- Used primarily to treat organism of the GI tract and to treat bacterial vaginosis****
- To prevent a disulfiram reaction patients must avoid alcohol and all alcohol
containing products during treatment and for 48 hours after treatment.
Week 4 – Chapter 37-39, 32-33
Chapter 37: Antineoplastic Agents
Cancer
• Cancer (malignant, neoplastic) cells are characterized by unregulated growth, lack
of differentiation and spread (metastasis) to other places in the body.
Anticancer Therapy:
• Chemotherapy is the use of chemicals to kill cancer cells by inhibiting or
preventing cell reproduction.
Classes of Chemotherapy Drugs:
- Alkylating Agents
- Antimetabolites
- Antitumor Agents
- Mitotic Inhibitors
- Hormonal Agents
Antimetabolites
Folic Acid Antagonist
- Methotrexate (Trexall) – Used to treat cancer, rheumatoid arthritis, psoriasis. INDUCES
MISCARRIAGES in patients with ectopic pregnancy.
General side effects: Bone suppression leading to leukopenia, thrombocytopenia, and
anemia. Can cause stomatitis, vomiting, alopecia, and hepatic/renal dysfunction.
Patients should report any signs of bleeding and have platelet levels checked.
Alkylating Drugs
Nitrogen Mustard
- Cyclophosphamide (Cytoxan) is used to treat Hodgkin’s disease and many other types of
cancer.
- This drug can cause hemorrhagic cystitis as result of severe bladder inflammation
- This drug should be taken with copious amounts of water and early in the day, so it does
not accumulate in the bladder.
Chapter 38: Targeted Therapies to treat cancer
Targeted Therapy:
, - Drugs or other substances that block the growth and spread of cancer by interfering with
specific molecules in tumor growth and progression.
- Cancers that do not have sufficient quantities of the specific molecular target will not
respond to targeted therapy.
Chapter 39: Biological Response Modifiers
Colony Stimulating Factors:
- Erythropoietin (Epoetin Alpha) stimulates red blood cell production, and increases
the risk of death when a patient’s hemoglobin is >12
Chapter 32: Anti-TB, Antifungal, Peptides, Metronidazole
Tuberculosis is caused by a bacterium call mycobacterium tuberculosis. The bacteria usually
attack the lungs, but TB bacteria can attack any part of the body, such as the kidney, spin, and
brain. If not treated properly, TB disease can be fatal.
- TB is one of the world’s top health challenges: More than 2 billion people, equal to a
QUARTER of the world’s population are infected with TB.
- Each year there is 9 million new cases and 1.5 million deaths
- Each day there is 24,000 new cases, 4000 deaths and 8,000 missed.
Latent TB Infection – TB bacteria can live in the body without making you sick. This is called
Latent TB Infection. In most people who breathe in TB bacteria and become infected, the body
is able to fight the bacteria to stop them from growing. People with this condition do no not feel
sick and do not have any symptoms. People with this condition are not infectious and cannot
spread TB bacteria to others.
TB Disease – TB bacteria becomes active if the immune system can’t stop them from growing.
When TB bacteria are active, multiplying in your body, this is called TB disease. People with
TB disease are sick. They may also be able to spread the bacteria to people they spend time
with every day.
- Mycobacterium have a thick, way cell wall. It is very tough!
Main Symptoms of Pulmonary Tuberculosis:
- Appetite Loss
- Fatigue
- Chest Pain
- Coughing up blood
- Productive, prolonged cough
- Night sweats, pallor
Anti- Tuberculars
TB Treatment
,- To prevent drug resistance – Multidrug Therapy (The golden standard of
treatment)
- Drugs: Isoniazid, Rifampin, Ethambutol, and Pyrazinamide*******
Rifampin
- Antimycobacterial
- Must be taken daily for several months with no break.
- Can stain body fluids orange.
- Can cause hepatotoxicity
- Take on empty stomach or absorption reduced by >30%***
- First discovered in soil from the French Riviera
Isoniazid
- Antimycobacterial
- BLACK BOX WARNING: Hepatoxicity
- Drug to Drug Interactions: Acetaminophen due to increased risk of liver damage***
- Drug of choice for pregnant women with TB
- Treats Latent and Active TB
- Can cause peripheral neuropathy in patients with vitamin B6 deficiencies
- First tested in the Navajo community Many Farms, AZ
Ethambutol
- Can cause vision problems, including optic neuritis and red green color blindness.
- Ok to take while breast feeding
- Antimycobacterial
Pyrazinamide
- Give in first months of combo therapy to reduce the total length of treatment (by
months)******
- Can cause arthralgia (joint pain), peripheral neuropathy, and hepatoxicity ***
-
Drug Resistance TB
- TB drug resistance is a major public health problem that threatens progress made in TB
care and control worldwide. This improper use is a result of a number of actions
including, administration of improper treatment regimens and failure to ensure that
patients complete the whole course of treatment.
- Extensively drug-resistant TB. MDR TB is caused by an organism that is resistant to at
least isoniazid and rifampin, the two most potent TB drugs.
- “Totally Drug-Resistant” tuberculosis: a WHO consultation on the diagnostic
definition and treatment options.
TB Vaccine
, - The Bacille Calmette-Guerin (BCG) vaccine has existed for 80 years and is one of the
most widely used of all currect vaccines, reading >80% of neonates and infants in
countries where it is part of the national childhood immunization programmer. BCG
vaccine has a documented protective effect against meningitis and disseminated TB in
children.
- The World Health Organization recommends that in countries with a high rate of TB
burden all infants should receive one dose of BCG attenuated live vaccine, as soon as
possible after birth.
Antifungal Drugs
Fungal Infections
- Can be topical or systematic
- Can be opportunistic or non-opportunistic
- Can be mild to life-threatening
- Can be caused by antibiotic or steroid use
- In the mouth, it is called Thrush***
Nystatin (Myostatin)
- Antifungal Drug
- Action: Binds to fungal cell membranes, causing cell contents to leak out = death
- Use: Topical treatment of fungal infections. Not absorbed in the GI system, so safe to
give orally.
- Elizabeth Lee Hazen and Rachel Fuller Brown discovered nystatin
- Swish and Swallow!!
Fluconazole (Diflucan)
- Antifungal Drug
- Used to treat candida infections and cryptocoal meningitis
- Pregnancy Category C, give with caution
Peptide Antibiotics
Bacitracin
- Effective against gram positive and some gram-negative bacteria
- Available OTC as ointment for application to the skin
- Peptide Antibiotic
Metronidazole
Metronidazole (Flagyl)
- Impairs DNA function of susceptible bacteria
- Used primarily to treat organism of the GI tract and to treat bacterial vaginosis****
- To prevent a disulfiram reaction patients must avoid alcohol and all alcohol
containing products during treatment and for 48 hours after treatment.
