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Clinical Pharmacy

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  1 C LINICAL P HARMACY      C EPHALOSPORINES “K EFLEX ,   V ELOSEF ”:      They are very similar to broad-spectrum ampicillins, but they are resistant to penicillinase.    They are used instead of penicillin in staph. aureus infections.    They interfere with glucose test in urine.    E RYTHROMYCINS “M ACROLIDE A NTIBIOTICS ”:      This is the drug of choice in patients sensitive to penicillins.    The drug of choice for Legionaries disease and mycoplasma pneumonia.    It can be used during pregnancy.    The oestolate salt of erythromycin has greater blood level than the stearate salt, but it may cause cholestasis, because the route of elimination of erythromycin is the liver (via bile).    L INCOMYCIN “L INCOCIN ”    –   C LINDAMYCIN “D ALACIN ”:      Macrolides type of antibiotic.    Restricted only for anaerobic infections.    They develop serious diarrhea and colitis (pseudomembranous colitis).    V ANCOMYCIN :    It’s a bactericidal antibiotic against gm +ve bacteria.      It’s used in the treatment of penicillin resistant infections.      It’s used orally in the treatment of antibiotic induced  pseudomembranous colitis.    Because 1 gm provides adequate blood levels for 7  –  10 days, I.V. vancomycin is especially useful in the treatment of anephric patients with gm +ve bacterial infections.    T ETRACYCLINE :    They are bacteriostatic.    They inhibit protein synthesis in bacteria.    Most valuable to patients with mixed infections.    There is cross-sensitivity and cross-resistance between all tetracyclines.    Long acting tetracyclines are Doxycycline “Vibramycin” and Minocycline “Minocin”.      Tetracyclines have the following side effects: b. Gastrointestinal side effects. c. Photosensitivity.  2 d. Fanconi’s syndrome.  e. Tooth discoloration as a result of complex formation with calcium ions in children. FFF AAANNNCCCOOONNNIII ’’’ SSS  SSS  Y Y YNNNDDDRRROOOMMMEEE :::   iiisss ccchhhaaar r r aaacccttteeer r r iiizzzeeeddd bbbyyy nnnaaauuussseeeaaa,,, vvvooommmiiitttiiinnnggg,,, pppooolllyyyuuur r r eeeaaa,,, aaannnddd aaaccciiidddooosssiiisss aaannnddd iiittt ’’’ sss cccaaauuussseeeddd bbbyyy ttthhheee aaadddmmmiiinnniiissstttr r r aaatttiiiooonnn ooof f f  eeexxxpppiiir r r eeeddd ttteeetttr r r aaacccyyycccllliiinnneee...     C HLORAMPHENICOL :    It inhibits bacterial protein synthesis.    It’s most valuable in the treatment of gm +ve and gm – ve infections  –  e.g. Salmonella, Rickettsia and also against ampicillin resistant H. influenza.     Adverse effects include: f. Bone marrow depression and agranulocytosis. g. Idiosyncratic aplastic anemia. h. Gray Syndrome or Gray-baby syndrome (in new born). Mechanism of action of antibiotics: I NHIBITION OF CELL WALL SYNTHESIS   Penicillins, cephalosporines, bacitracin, cycloserine and vancomycin I NHIBITION OF CELL MEMBRANE FUNCTION    Amphotricin B, imidazoles, polymixins, colistin, polyenes and nystatin. I NHIBITION OF PROTEIN SYNTHESIS   Chloramphenicol, erythromycines, lincomycin, tetracycline and aminoglycosides. I NHIBITION OF NUCLEIC ACID SYNTHESIS   Quinolones, pyrimethamine, rifampin, sulfonamides, trimethoprim and grieofulvin. N.B. Sulfa drugs inhibit growth by means of competitive antagonism. AAA NNNTTTIIINNNEEEOOOPPPLLLAAASSSTTTIIICCC  DDD RRRUUUGGGSSS    Antineoplastic drugs are classified into: 1. Interfering with DNA, RNA and protein (anti-metabolite): a. Methotrexate   Folic acid antagonist. b. 6-mercaptopurine   Purine antagonists. c. 5-fluorouracil   pyrimidine antagonists. d. Cytorabine   pyrimidine antagonist. 2. Inhibiting protein synthesis: a. L-asparaginase (Leukemia). 3. Interfering with the replication and translation of the DNA: a. Nitrogen Mustard (Mechlorethamine). b. Cyclophosphamide c. Actinomycin D. 4. Interfering with mitotic spindle formation: (Vinca Alkaloid) a. Vincristin.  3 b. Vinplastin. Another Classification:    A LKYLATING AGENTS :    These are highly reactive agents, which can alkylate or bind covalenty with cellular components of DNA.    They interfere with mitosis producing chromosomal damage, mutation and suppression of normal immune response by interfering DNA cross-linkage.    This group includes: a. Mechlorethamine (nitrogen mustard) given I.V. b. Chlorambucil (Leukeran) given orally. c. Cyclophosphamide (Cytoxan) given orally or parentrally. d. Melphalan (Alkeran) given orally. e. Busulfan (Myleran) given orally.    A NTIMETABOLITES :    They interfere with the cell synthesis of essential components by competing with the natural synthesis for the enzyme involved or synthesis of un-natural cell constituents.    They include: a. Methotrexate (Folic acid antagonist). b. 6-mercaptopurine (Purine antagonist). c. 5-fluorouracil (Pyrimidine antagonist). d. Cytosine arabinoside (Cytorabine).    V INCA A LKALOIDS :    They block microtubular precipitation, which is necessary for mitosis  –  i.e. bind with the tubulin so interfere with the assembly of spindle proteins during mitosis.    They include: a. Vincristin (Oncovin) used for acute lymphoblastic leukemia. b. Vinplastin (Velban) used for Hodgkin’s disease.      H ORMONES :    Corticosteroids (in lymphocytic leukemia).     Androgens (in breast cancer).    Estrogens (in prostatic carcinoma).    Progestines (in endometrium carcinoma).  4    A NTIBIOTICS :    They inhibit DNA synthesis.    They are used in cancer of stomach, colon, pancreas, breast and bladder.    They include: a. Actinomycin D (Dactinomycin) b. Mithramycin (Mithracin) c. Doxorubicin (Adriamycin) d. Mitomycin (Mutamycin) e. These are cytotoxic drugs (antibiotics).    M ISCELLANEOUS G ROUP : a. Procarbazine (Natulane), which is used in treatment of Hodgkin’s disease.  b. Nitrosureas is used in gastrointestinal malignancy. c. L-asparaginase (Elspar), which hydrolyses L-aspargin, thus inhibits protein synthesis.    R ADIOACTIVE I SOTOPES : These are isotopes of elements that emit  ,  , and   (gamma) ionizing radiations. But only  , and   radiation are used in cancer chemotherapy. They cause:    Inhibition of mitosis.    Inhibition of bone marrow.    Fetal abnormalities and chromosomal mutation.     Affection of reproductive system  –  i.e. amenorrhea in female and sterility in male.    They include: a. Iodine 131:   It has a half-life time about 8 days as NaI 131  given orally.   It emits   and   radiation.   Used in hyperthyroidism and thyroid cancer. b. Gold 198:   It has a half-life time about 2  –  7 days and is given parentrally.   It emits   and   radiation.   Used to inhibit ascitic and pleural effusion caused by metastatic neoplasma. c. Sodium Phosphorus 32 :   It has a half-life time 14.3 days and is given orally or I.V.   It emits   radiation only.   Used in treating Polycythaemia Vera because it follows the phosphate pool in body and concentrated in bone marrow, spleen and lymph nodes.

Aero Biology

Jul 23, 2017
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