·         Causes – family history of PUD, blood group O, smoking tobacco, consumption of beverages and food that contain caffeine, drugs such as NSAIDS and platelet inhibitors like aspirin, excessive psychological stress, and H. pylori infections     

   Signs and symptoms

o   A gnawing or burning upper abdominal pain that occurs 1-3 hours after a meal

o   Night time pain, nausea, and vomiting are uncommon

o   Loss of appetite

• TC: antiulcer drug
• PC: proton pump inhibitor
• Acts by reducing acid secretion in the stomach. Used to treat PUD.
• Can include headache, nausea, diarrhea, rash, and abdominal pain. 
• Contraindicated in pt. with hypersensitivity to the drug.
• Use with central nervous system depressants may cause increased blood disorders. 

Ranitidine

(Zantac)

• TC: antiulcer drug
• PC: H2-receptor antagonist
• Acts by blocking H2 receptors in the stomach to decrease acid production. Used to treat PUD and peptic ulcers. 
• Side effects are uncommon and mild. Rare reduction in red and white blood cells and platelets are possible. 
• Contraindicated in pt. with hypersensitivity to H2 receptors antagonists, acute porphyria, and OTC administration in children less than 12 years of age. Antacids should not be administered within 1 hour of H2 receptor antagonists.

• TC: anti-heartburn agent
• PC: antacid
• Acts by neutralizing stomach acid by raising the pH of the stomach contents. Used to treat heartburn due to PUD
• May include constipation, phosphate depletion. 
• Contraindicated in pt. with suspected bowel obstruction. Do not take at same time as other medications because they may interfere with absorption. 

• TC: bulk type laxative
• PC: natural product
• Acts by swelling when taken with sufficient amount of water and swelling fecal mass, thus causing peristalsis. 
• Rarely produces any side effects. If not taken with sufficient water it can swell in the esophagus and cause an obstructing. 
• Contraindicated in pt. with undiagnosed abdominal pain, intestinal obstruction, or fecal impaction. Can decrease the absorption and effects of warfarin, digoxin, antibiotics, and antidepressants. 

• TC: antidiarrheal 
• PC: opioid
• Acts by slowing peristalsis, allowing time for additional water reabsorption from the colon and more solid stools.
• Acts within 45-60 min. 
• Some patients may experience dizziness or drowsiness, and they should not drive until effects of the drug are known. 
• Contraindicated in pt. with hypersensitivity, severe liver disease, obstructive jaundice, severe dehydration or electrolyte imbalance, and diarrhea.

• TC: drug for inflammatory bowel disease
• PC: 5-aminosalicylate, sulfonamide. 
• Acts by inhibiting mediators of inflammation in the colon such as prostaglandins and leukotrienes. Used to treat mild-moderate ulcerative colitis. 
• May include nausea, vomiting, diarrhea, dyspepsia, and abdominal pain. Headache is common. Skin rashes are fairly common. May impair male fertility. 
• Contraindicated in pt. with sulfonamide or salicylate hypersensitivity. Pt. with anemia, folate disorders, or other hematologic disorders. Drug can cause hepatotoxicity. 
• Overdose will cause abdominal pain, anuria, drowsiness, gastric distress, nausea, seizures, and vomiting. 

• TC: antiemetic
• PC: phenothiazine antipsychotic
• Acts by blocking dopamine receptors in the brain, which inhibits signals to the vomiting center in the medulla. Used to treat nausea and vomiting. 
• Black box warning that elderly pt. with dementia who are treated with conventional phenothiazine’s are at an increased risk of death compared to placebo. 
• May include dry mouth, sedation, constipation, orthostatic hypotension and tachycardia. Prolonged use may cause symptoms resembling those in Parkinson’s.  
• Contraindicated in pt. with hypersensitivity to phenothiazine’s, in comatose pt., or in the presence of profound CNS depression. Do not use in children younger than 2 or weighing less than 20 lbs. Severe hepatic impairment. 

  Compare and contrast the properties of water-soluble and fat-soluble vitamins

•Water soluble vitamins – are easily absorbed with water in the GI tract. If excess amount of this vitamin are taken in then they are not absorbed and are excreted in the urine. These vitamins need to be taken in every day. 

•Fat soluble vitamins – are not easily absorbed. These vitamins are not easily absorbed in the small intestine unless absorbed with a high fat meal. These vitamins can be stored in the liver and lipid cells for use when sufficient levels are not taken in. This can cause problems though with too much of a vitamin being stored. 

  Identify indications for vitamin pharmacotherapy.

Vitamin A

• TC: lipid soluble vitamin
• PC: retinoid
• Acts by replacing a deficiency in vitamin A
• Side effects not observed with normal doses. Acute ingestion can cause CNS toxicity including headache, irritability, drowsiness, delirium, and possible coma. 
• Long term use can cause alopecia, anorexia, and leukemia. 
• Contraindicated in excess of the RDA in pregnant patients or those who may become pregnant. 

Folic acid

• TC: water soluble vitamin
• PC: none
• Acts by reversing symptoms of deficiency
• Side effects are very uncommon. 
• Pt. may feel flushed following IV injection. Allergic reaction is possible. 
• Contraindicated in pt. with anemia’s caused by anything other than folate deficiency. 

• TC: magnesium supplement 
• PC: electrolyte 
• Acts by rapidly reversing signs of hypomagnesia 
• Side effects may include flushing of the skin, sedation, confusion, intense thirst, and muscle weakness. 
• Can cause respiratory paralysis. 
• Contraindicated in pt. with serious cardiac disease. 
• Oral administration should not be used in pt. with undiagnosed abdominal pain, intestinal obstruction, or fecal impaction. 

• TC: antiobesity drug
• PC: lipase inhibitor
• Acts by blocking the absorption of dietary fats in the small intestine. Used to treat those with a BMI of 27 or greater.
• May include flatus with discharge, oily stool, fecal urgency, and abdominal pain. May impair the absorption of Coumadin. Headache is also a common side effect. 
• Contraindicated in pt. with a hypersensitivity to the drug, malabsorption syndromes, gallbladder disease, hypothyroidism, organic causes of obesity, anorexia nervosa, and bullemia nervosa. 

 Describe the role of calcium in the body in maintaining homeostasis in the nervous, muscular, and nervous systems. 

• TC: Calcium supplement
• PC: hypocalcemia agent
• Acts by increasing the body’s levels of calcium. Used to treat osteoporosis, Paget’s disease, osteomalacia, and problems during pregnancy.
• May include hypercalcemia, drowsiness, lethargy, weakness, headache, anorexia, nausea, vomiting, increased urination, and thirst. 
• If extravasation occurs, severe necrosis and sloughing of the skin may result. 
• Contraindicated in in patients with ventricular fibrillation, metastatic bone cancer, or hypercalcemia. 
• Zinc rich food decreases the absorption of calcium. 

Calcitriol (Rocaltrol)

• TC: Vitamin D
• PC: Bone resorption inhibitor
• Acts by  increasing vitamin D levels in the body and slowing calcium reabsorption. Used to treat hypoparathyroidism. 
• May include anorexia, vomiting, blurred vision, photophobia, constipation, metallic taste, headache, weakness.
• Contraindicated in pt. with hypercalcemia or vitamin D toxicity. 

• TC: drug for osteoporosis
• PC: bisphosphonate; bone resorption inhibitor
• Acts by lowering serum alkaline phosphatase, the enzyme associated with bone turnover. Used to prevent and treat osteoporosis. 
• May include diarrhea, constipation, flatulence, nausea, vomiting, metallic taste, hypocalcemia, hypophosphatemia, headache, and rash. 
• Contraindicated in pt. With osteomalacia or abnormalities of the esophagus. 
• Take on an empty stomach
• Need to remain standing at least 30 min. after taking

Pruritus

• TC: anti-acne drug
• PC: retinoid
• Acts by preventing and treating the symptoms of acne. 
• May include skin redness, scaling, erythema, crusting, and peeling of skin. Headache, nausea, vomiting. 
• Black box warning that pt. with APL are at high risk for serious adverse effects. About 25% of pt. develop retinoic acid-APL syndrome.  
• Avoid sunlight
• Do not use any OTC acne medications with this

Closed-angle glaucoma

Iatanoprost (Xalatan)

• TC: anti-glaucoma drug
• PC: prostaglandin analog
• Acts by reducing IOP by increasing the outflow of aqueous humor. Used to treat open-angle glaucoma. 
• May include conjunctival edema, tearing, dryness, pain, irritation. 
• Eyelashes on the treated eye may grow thicker and darker. 
• Contraindicated in pt. with hypersensitivity to the drug, pregnancy, lactation, intraocular infection, or conjunctivitis. 

• TC: anti-glaucoma drug
• PC: Miotic; beta-adrenergic antagonist
• Acts by lowering IOP in chronic open-angle glaucoma by reducing the formation of aqueous humor. 
• May include. Local burning and stinging on installation. Vision may become temporarily blurred. 
• If drug is absorbed then hypotension can occur. 
• Contraindicated in pt. with asthma, severe chronic obstructive pulmonary disease, sinus bradycarcia, second or third degree AV block , heart failure. 

Designer Drugs

Physical dependence

Alcohol

Marijuana

Opioids

Diabetes Type 2

• Sedative Hypnotic 
• Acts on GABA receptors to treat insomnia 
• Daytime sedation and amnesia
• Lactating women should not take. 

• TC: antidepressant
• PC: selective serotonin re-uptake inhibitor
• Used for the treatment of depression, anxiety, obsessive-compulsive disorder, and panic. 
• Agitation, insomnia, headache, dizziness, somnolence, and fatigue
• Can increase suicidal thoughts in young people, no specific treatment for overdose

• TC: analgesic, anti-inflammatory drug, antipyretic
• PC: NSAID
• Acts by inhibiting prostaglandin synthesis. 
• Used to treat moderate pain, fever, and inflammation. 
• Nausea, heartburn, dizziness, GI ulceration. 
• Pt. with peptic ulcers should not take.
• Garlic and ginger can increase risk of bleeding. 

• TC: NON-NARCOTIC ANALGESIC, ANTIPYRETIC
• PC: ANALGESIC
• INHIBITS PROSTOGLANDIN SYNTHESIS
• USED FOR PAIN AND FEVER IN INFANTS, CHILDREN, AND ADULTS
• HEPATOTOXICITY (MAXIMUM DOSE 4G/DAY)
• Contraindicated in chronic alcoholics. Overdose treated with acetadote. 

• TC: Thyroid hormone
• PC: Thyroid hormone replacement
• Used for replacement therapy in patients with low thyroid function
• Can result in hyperthyroidism; fast heart rate, heart palpitations, weight loss.
• Contraindicated in patients who are hypersensitive to the drug, experiencing thyrotoxicosis, or have severe cardiovascular conditions

• TC: adrenal hormone
• PC: corticosteroid
• Prevent/suppresses immune reactions; adrenocortical insufficiency, anti-inflammation, immunosuppressive
• Topical side effects are rare. Systemic side effects may include Cushing’s disease, tachycardia, insomnia, anxiety, headache, vertigo, confusion, and depression.
• Contraindicated in patients are who are hypersensitive to the drug or who have known infections

• TC: Drug for hypertension and angina
• PC: Calcium channel blocker
• Acts by selectively blocking calcium channels in myocardial and vascular smooth muscle, including those in the coronary arteries. This results in less oxygen utilization by the heart, an increase in cardiac output, and a fall in blood pressure. 
• Used for HTN and variant or vaso-spastic angina
• Adverse effects are generally minor and can include headache, dizziness, peripheral edema, and flushing. Immediate acting forms can cause reflex tachycardia. In rare cases can cause an increase in anginal pain.
• Pregnancy category C. 
• Contraindicated in patients with prior hypersensitivity. 
• Overdose treated with vasopressors.  

• TC: anti-hyperlipidemic
• PC: HMG – CoA reductase inhibitor, statin
• Primary indication is hypercholesterolemia. 
• Act by inhibiting HMC-CoA reductase.
• Heachache, cramping, diarrhea, and constipation. Possible liver damage
• Contraindicated in patients with serious liver disease. 
• Grapefruit juice inhibits metabolism. 
• Interacts with azole antifungals, HIV protease inhibitors, and telaprevir.

• TC: Drug for heart failure and HTN
• PC: Diuretic (Loop type)
• Used in the treatment of acute HF because it has the ability to remove large amounts of excess fluid from the patient in a short period. 
• Acts by preventing the reabsorption of sodium and chloride in the loop of Henle region of the nephron.
• Pregnancy category C, potential electrolyte imbalances, hypokalemia, excess fluid loss, dehydration, and hypotension, orthostatic hypotension and syncope, ototoxicity.
• Contraindications include hypersensitivity to the drug, sulfonamides, anuria, hepatic coma, and severe fluid or electrolyte depletion.

• TC: Class II anti-dysthymic
• PC: beta-adrenergic antagonist
• Acts by reducing heart rate, slowing myocardial conduction velocity, and lowering BP. 
• Most effective in treating tachycardia that is caused by excessive sympathetic stimulation. 
• Used for HTN, angina, and migraine headaches, and for the prevention of MI.
• Side effects may include fatigue, hypotension, and bradycardia. May cause diminished libido in men. Should be used cautiously in patients with diabetes. Should be used with caution in patients with reduced urine output.
• Contraindicated in patients with cardiogenic shock, sinus bradycardia, greater than first degree heart block and HF, COPD, or asthma. 
• Overdosed treated using vasopressors.

Warfarin (Coumadin)

• TC: anticoagulant
• PC: Vitamin K antagonist
• Acts by inhibiting the action of vitamin K which is crucial for producing clotting factors
• Abnormal bleeding is the most severe side effect. 
• Contraindicated in pt. with recent trauma, active internal bleeding, and bleeding disorders. 
• Constant monitoring of blood levels with PT/INR test is necessary. INR of 2.0-3.0 is desired for those on warfarin. 

Rapid -acting: Humalog (Lispro)

• clear
• onset: 5-15 min
• peak: 30 min-1 hour
• duration: 3-4 hours

Short-acting: Humulin R

• clear
• 30-60 min
• 2-4 hours
• 5-7 hours

Intermediate-acting: Humulin N

• clear
• 1-2 hours
• 4-12 hours
• 18-24 hours

Long-acting: glargine (Lantus)

• clear
• 1.1 hours
• 3-4 hours
• 10-24 hours