Pharmacology principles and applications

Mr. Everett is diagnosed with Tinea Pedis and Tinea Corporis. What is his problem? How might he have acquired this problem? What classification of anti-infective drugs would be ordered for his treatment? Name three drugs and dosages. Are the drugs RX and/or OTC? What are adverse effects and contraindications? Can they be ordered for children, pregnant and the eldery patients? Are there herbal or alternative products available? What educational point should be noted for him and his family?

Tinea Pedis is more commonly known as athlete's foot. It is a fungal infection of the foot caused by parasites on the skin called dermatophytes. This is a contagious condition caused by excess moisture in the foot area. The moisture can be from excess sweating or from not properly drying the foot area. It can be spread by skin to skin contact or through the sharing of towels, socks, and shoes. It can even be contracted off of the floor. Athlete's foot is characterized by red, itchy patches between and around the toes, possibly small pustules, and a small degree of scaling. Athlete's foot can actually spread to other parts of the body, and in this case is called Tinea Corporis. Tinea Corporis is when a person has athlete's foot on any part of the body other than the foot area.

Tinea Pedis and Tinea Corporis can be treated with anti-fungal creams, sprays, liquids and powders. There are many products available without a prescription. However, if the case is severe, there are also some ointments available with a prescription. Three types of medications used to treat this condition are 1.) Canesten AF cream, 2.) Daktarin cream, and 3.) Lamisil AT cream.

Canesten AF cream is a medication that contains the active ingredient clotrimazole, which is an antifungal medicine used to treat infections with fungi and yeasts. This medication is available in cream, spray or powder form. It should be applied to a dry foot when needed to prevent iching and spreading of the rash. There is no information on this medication and its effect on pregnancy. All pregnant women should consult their doctor before using this medication. It is ok to use on elderly and younger patients, but discontinue use if any signs of an allergic reaction occurs. There are no interaction possibilies with other medications. The side effects can occur on anyone and usually include a burning or warm sensation to the applies area or irritation to the skin. Educational point: Be aware that Tinea Pedis and Tinea Corporis are contagious and can easily be spread through skin to skin contact and off of floors and furniture. Affected areas should be covered and protected. If symptoms persist or become worse, the patient should consult their doctor. Acidophilus is an alternative treatment and is available in supplements or yorgurt.

Daktarin cream is another medication used to treat Tinea Pedia and Tinea Corporis. Daktarin cream contains the active ingredient miconazole. Miconazole is an antifungal medicine used to treat infections with fungi and yeasts. This medication is especially good for Tinea Corporis because it can also be used to treat ring worm, gential fungal infections, nappy rash and scalpel infections. This medication is applied twice a day to the affected area. Most studies show that it does not interact with other medications, however, the patient should inform the doctor if he/she is taking Warfarin to prevent blood clots. There is a very small chance that this medication will interact with Warfarin, which is used to prevent blood clots, so the doctor may want to monitor the blood clotting while using Daktarin. It is ok to use on children aged 6 and older and on the elderly. Attention should be given to allergic reactions. The medication should be used for ten days. After ten days, if the symptoms persist or reoccur, the patient should contact his/her doctor. Pregnant women should consult with a doctor before using Daktarin, however studies have not shown any risk to pregnancy due to use of this medication. The main side effect is irritation of the affected area. Acidophilus is an alternative treatment for this medication and is available in supplements or yorgurt.

Lamasil AT cream is the third medication used to treat Tinea Pedis and Tinea Corporis. Lamisil AT cream contains the active ingredient terbinafine hydrochloride, which is an antifungal medicine used to treat infections caused by fungi. This cream is applied to the affected area as need and is not recommended for use by pregnant or breastfeeding women or children under the age of 16. It is ok to use with elderly patients, but attention should be given to any allergic reaction. Side effects include: redness of the skin, itching of the affected area, and a stinging sensation. Acidophilus is an alternative treatment for this medication and is available in supplements or yorgurt.

Part #2

Antineoplastic and immunological drugs are ordered for a patient with a dx of Cancer of various organs/systems. Name 4 categories of drugs used for treatment. What are the types of cancers the physician might order the drugs for? What combinations would be ordered? What are the major and common side-effects noted? What are the contraindications noted? What are the educational opportunities you would share with the patient and family?

Four categories of Antineoplastic and immunological drugs are: 1.) Antineoplastic Adjuvants, 2.) Antineoplastic Hormones, 3.) Antineoplastic Radiopharmaceuticals, and 4) Antineopastic Topical treatments. These medications are used to treat cancers such as myeloma, lymphoma, and breast cancer. Possible combinations of the antineoplastic drugs include busulfan, cyclophosphamide, ifosfamide, mechlorethamine, thiptepa, and melphalan. Side effects of antineoplastic medications include, but are not limited to: allergic reactions (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives); decreased bone marrow function and blood problems (extreme fatigue; easy bruising or bleeding; black, bloody or tarry stools; fever or chills; or signs of infection such as fever; chills, or sore throat); seizures; skin rash; yellowing of the skin or eyes; persistent cough; missed menstrual periods, or unusual lumps or masses. In some cases secondary cancers have been reported while using these medications. Contraindications include: hypersensitivity to azathioprine and mercaptopurine. Educational Information for the family: Antineoplastic medications are used as Chemotherapy to treat various forms of cancer. Chemotherapy refers to medicines that can kill or control cancer. Chemotherapy medicines target and treat a specific area affected by cancer. These medicines travel to all parts of the body through the bloodstream. Chemotherapy is a systemic treatment, which means it is a treatment that affects the whole body. There are many kinds of chemotherapy. The medicine chosen will depend on the type and the extent of the cancer, as well as the potential side effects of the medicine. Each medicine will have its own specific side effects. Most of the time, chemotherapy is given as an outpatient procedure in a clinic or a doctor's office. People generally do not need to stay overnight in the hospital to receive chemotherapy.

Part #3

The function of the GU and GI systems is to digest and change food products for body fuel and fluid balance, elimination of waste/toxins and reabsorbtion of necessary chemicals for bodily function. Name 4 disorders related to the two systems. Name 2 drugs for each diagnosis, why are they ordered, adverse effects, contraindications and education for the patients and families. Are OTC/herbal products available?

Four disorders of the GU and GI system are: 1.) Gastroenteritis, 2.) Irritable Bowel Syndrome (IBS), 3.) Prostatitis, and 4.) Acute bacterial epididymitis.

Gastroenteritis is inflammation of the stomach and small intestine and is sometimes referred to as the "stomach flu." Two medications that are used to treat this illness in mild to moderate cases are Loperamide and Bismuth Subsalicylate. Loperamide is prescribe to help the stomach and abdominal muscles move the food from one end to the other. Side effects are not common with loperamide but constipation and/or bloating are possibilities. Since loperamide is an opiate, tranquilization is a possible side effect. The family should be educated about the importance of rest while taking lopermide and that proper hydration is very important. The patient should gradually begin eating again, beginning with easy to digest foods and avoid spicy foods until the gastroenteritis is eliminated.

Bismuth Subsalicylate is used to treat diarrhea, which is a common symptom of gastroenteritis. It is sold over the counter and is more commonly called Pepto Bismol. There are several possible side effects for this medication which include: Anxiety; any loss of hearing; confusion; constipation (severe); diarrhea (severe or continuing); difficulty in speaking or slurred speech; dizziness or lightheadedness; drowsiness (severe); fast or deep breathing; headache (severe or continuing); increased sweating; increased thirst; mental depression; muscle spasms (especially of face, neck, and back); muscle weakness; nausea or vomiting (severe or continuing); ringing or buzzing in ears (continuing); stomach pain (severe or continuing); trembling; uncontrollable flapping movements of the hands (especially in elderly patients) or other uncontrolled body movements; vision problems. Patient should be informed of the importance of hydration while taking this medication. Contraindications include false sugar readings in diabetic patients. This medication can also cause a black tongue or dark stool.

Irritable bowel syndrome is another gastrointestinal disorder. Irritable bowel syndrome, or IBS, is a problem that affects mainly the bowel, which is also called the large intestine. The bowel is the part of the digestive system that makes and stores stool. The word syndrome means a group of symptoms. IBS is a syndrome because it can cause several symptoms. For example, IBS causes cramping, bloating, gas, diarrhea, and constipation. Two medications that are used to treat irritable bowel syndrome are: 1.) laxatives and 2.) antispasmodics. Oral laxatives are medicines taken by mouth to encourage bowel movements to relieve constipation, which is a common symptom of IBS. Side effects include dizziness, nausea, vomiting, cramping, gas, and increased thirst. A contraindication of any laxative is dehydration. Advice to the patient and the patient's family would include education about proper diet, rest and exercise. If symptoms persist more than 10 days, a doctor should be consulted. Laxatives should not be taken while operating machinery or driving a car.

Prostatitis is a gastrourinary disorder that affects the prostate. The term prostatitis is applied to a series of disorders, ranging from acute bacterial infection to chronic pain syndromes, in which the prostate gland is inflamed. Patients present with a variety of symptoms, including urinary obstruction, fever, myalgias, decreased libido or impotence, painful ejaculation and low-back and perineal pain. Acute bacterial prostatitis is treated with antibiotics such as flouroquinolones and trimethoprim-sulfamethoxazole. The side effects of these two types of prostate medication are similar. They include: diarrhea, dizziness, headache, nausea, stomach pain, and vomiting. Sometimes surgery is required if the prostate is damaged or badly infected. Contraindications of flouruquinolones are they are not recommended for children under 12. Contraindications for trimethoprim-sulfamethoxazole include patients with liver or kidney disease and chronic alcoholics. Patient and patient's family should be advised of the seriousness of the condition. All medication should be completed regardless if the condition gets better.

Acute epididymitis is another gastrourinary disorder. Acute epididymitis is an inflammatory process generally caused by either sexually transmitted organisms or gram-negative bacteria. Typical symptoms include swelling, pain, fever, and scrotal hyperemia. At times, these occur concomitantly with acute cystitis, acute urethritis, or acute prostatitis episodes. Complications from epididymitis include chronic pain, infertility, epididymo-orchitis, abscess formation, and rarely, testicular infarction. The etiology of acute epididymitis is often a sexually transmitted pathogen in sexually active males due to gonorrhea or chlamydia and other organisms that cause urethritis or cystitis. Two medications that are used to treat acute epididymitis. Epididymitis is generally treated with 4 to 6 weeks of oral antibiotics. Hospitalization and intravenous antibiotics may be needed for severe infections. Two medications used to treat acute epididymitis are: Ceftriaxone and Doxycycline. The side effects for Ceftriaxone are upset stomach, stomach pain, diarrhea, and vomiting. Hypersensitivity is a contraindication for Ceftriaxone. The side effects for Doxycycline are difficulty breathing, vomiting, nausea, stomach pain, headache, blurred vision, confusion, loss of apetite and clay colored stools. Contraindications include hepatic disfunction and hypersensitivy. Advice for patients with acute epididymitis is bedrest. It is important that the patient gets sufficient bedrest. A pillow can be placed between the legs to ease any pain and all sexual activity should subside for at least 4-6 weeks. All medication should be taken regardless if the condition gets better. If condition worsens, a doctor should be consulted. This condition does not go away quickly. Symptoms can last up to 12 weeks and can be reoccurring.

There are alternative treatments for GU and GI disorders. Some of the herbal treatments include Ginkgo Balboa, Ginseng, Huperzine A, and Ma Huang. Eating a proper diet that includes various fruits and vegetables is also recommended for the prevention of GU and GI disorders. Avoid diets that are high in fats, calories, grease, and other unhealthy substances.