SECTION 11 WOMEN’S HEALTH
contraception containing estrogen and a progestin,
45 CONTRACEPTION
• The term “contraception” is defined as the
intentional prevention of pregnancy.
• Contraception (birth control) prevents
pregnancy by interfering with the normal
process of ovulation, fertilization, and
implantation.
• Contraception choices have medical,
personal and public health considerations.
• The personal aspects include issues related
to sexuality, religious, or cultural beliefs.
• Medical conditions that affect contraceptive
selection or the risks associated with
pregnancy also must be considered.
• are therefore pharmaceuticals or devices that
prevent pregnancy.
GOAL
- The goal of contraception “therapy” is to
prevent unintended pregnancy without
causing adverse effects and to preserve
fertility, when desired.
COMPARISON OF CONTRACEPTIVE
METHOD EFFECTIVENESS
The effectiveness of any contraceptive method
depends on its mechanism of action, availability
(e.g., if a prescription is required, cost), adherence,
and acceptability (e.g., side effects, ease of use,
religious and social beliefs).
Manipulating the normal physiologic feedback
mechanisms of the menstrual cycle using estrogen
and progestin has proved to be an effective method
of contraception.
Estrogens are hormones that are important for
sexual and reproductive development, mainly in
women.
Progestin is a natural or synthetic steroid hormone,
such as progesterone, that maintains pregnancy and
prevents further ovulation during pregnancy.
The most commonly used reversible method of
and are very effective in preventing pregnancy is
the COMBINATION ORAL
CONTRACEPTIVE PILLS (COC)
Oral Contraceptive Risks and Adverse Effects
Some women may not be candidates for a COC
because of the risks and adverse effects associated
with use.
Other women may experience minor side effects
with COC that may be managed by changing to a
formulation with a different type or dose of estrogen
or progestin.
Benefits of Oral Contraceptives
Acne
• Depending on the woman, COC use may
cause acne to appear, disappear, or
significantly improve.
• Most women will have improvement in acne
with any COC used, only a few formulations
are FDA approved for this indication.
Benign Breast Disease
• A 50% to 75% reduction in the risk of
fibroadenomas, chronic cystic breast
disease, and breast biopsies appears to exist
in COC users.
• The progestin component may be primarily
responsible for this protection, progestin-
dominant COCs that contain a less
estrogenic progestin such as levonorgestrel,
are preferred.
Dysmenorrhea and Premenstrual Syndrome
• Premenstrual tension has been reported to be
reduced 29% in COC users, and other
premenstrual symptoms seem to be relieved
as well.
Endometrial Cancer
• Clinical data suggest that cyclic COCs
contain sufficient progestin to prevent
endometrial hyperplasia and to reduce the
 risk of endometrial cancer by about 50% to
70%.
• The protection is directly related to duration
of use and may persist for many years after
discontinuation.
• A meta-analysis of 11 studies showed a
56%, 67%, and 72% reduction in
endometrial cancer risk after 4, 8, and 12
years of COC use, respectively.
Menorrhagia (Heavy Menstrual Bleeding)
• The total amount of menstrual flow in
established COC users is decreased by up to
40%, which may caused by the progressive
thinning of the endometrium induced by use
or a lack of irregular bleeding.
• Bleeding may be decreased the most by
COCs that have a high ratio of progestin to
estrogen, because endometrial thinning is
maximized.
Ovarian Cancer and Functional Ovarian Cysts
• The risk of developing functional ovarian
cysts is decreased, pre-existing cysts are
more rapidly resolved, and surgery rates for
ovarian masses are reduced in women taking
COCs.
• This is likely owing to reducing ovulation,
suppressing androgen production, or
increasing progesterone levels.
Pelvic Inflammatory Disease and Ectopic
Pregnancy
• Many clinicians prefer to prescribe COCs
with condoms for STD protection to young
women with multiple sexual partners
because PID has been found to be less
prevalent with this combination of
contraceptive methods.
• The risk of ectopic pregnancy is greater for
women who already have had PID, and
COC use has been shown to prevent
hospitalizations and deaths stemming from
ectopic pregnancies.
Other Issues with Oral Contraceptives
• Breast Cancer
• Depression
• Diabetes
• Gallbladder Disease
• Use During Pregnancy and Breastfeeding
46 OBSTETRIC DRUG THERAPY
Prenatal Care
• The goal of prenatal care is to promote a
safe and successful pregnancy and the
delivery of a healthy infant, can be achieved
through education and by monitoring the
health of the mother and fetus.
Conception begins with the fertilization of
an ovum.
• Conceptional or Developmental Age
– Is the time after conception.
• Gestational age or Menstrual Age
– is the time from the start of the last
menstrual period (LMP) and
generally exceeds the developmental
age by 2 weeks.
Definitions
• Parity and Gravida
– Parity and Gravida are terms used to
describe a pregnant woman.
Parity - is the number of deliveries after 20
weeks’ gestation.
Gravida - refers to the number of
pregnancies a woman has had regardless of the
outcome.
Trimesters of Pregnancy
• The average pregnancy is approximately 280
days or 40 weeks when calculated from the
 first day of the LMP (Last Menstrual
Period).
• Pregnancy is typically divided into three
trimesters, approximately 13 to 14 weeks
each.
Delivery
• Depending on the gestational age at the time
of delivery, the result can be an abortion,
preterm, term, or post-term birth.
• Abortion (Spontaneous or Terminal)
• is a delivery before 20 weeks’
gestation.
• A term infant is a fetus delivered between 37
and 42 weeks gestation.
Preterm Birth
– is one occurring
between 20 and 37
weeks’ gestation.
Post-term Birth (Postmaturity)
– birth occurs after the
beginning of 43
weeks’ gestation.
– Parturition refers to
labor, and the
Puerperium is the 6 to
8 weeks after
delivery.
VITAMINS AND MINERALS
• Iron Requirements
– Iron requirements increase during
pregnancy because of maternal blood
volume expansion, fetal needs,
placenta and cord needs, and blood
loss at time of delivery.
• Folate Requirements
– Folic acid is essential in the synthesis
of DNA and RNA. Pregnant women
who take 0.4 to 0.8 mg of folic acid
daily during the first trimester of
pregnancy are significantly less
likely to have a child with neural
tube defects (NTD).
• Calcium Requirements
– Calcium is needed during pregnancy
for adequate mineralization of the
fetal skeleton and teeth, especially
during the third trimester when teeth
are formed and skeletal growth is
greatest.
DIABETES MELLITUS
• Diabetes mellitus is the most common
maternal medical complication during
pregnancy.
Diabetes during pregnancy can be detected
before or during pregnancy and can be separated
in two groups:
(a) Pregestational Diabetes, which includes women
who have been diagnosed before pregnancy with
either insulin dependent or insulin-independent
diabetes mellitus.
(b) Gestational Diabetes Mellitus (GDM) defined as
carbohydrate intolerance first detected during
pregnancy.
INSULIN THERAPY
• Insulin is the hypoglycemic of choice during
pregnancy because it does not cross the
placenta and has an established safety record
for both mother and fetus.
• The goal with insulin therapy is to imitate
the glucose levels of a healthy pregnant
woman.
ORAL HYPOGLYCEMICS
• Oral hypoglycemics are used commonly to
treat type 2 diabetes in nonpregnant women.
• With more than half of pregnancies being
unplanned, many discover their pregnancy
status while taking these medications.
• A switch to insulin therapy is recommended
before conception, if possible, or at the time
 the pregnancy is confirmed because many
patients have inadequate control with oral
ALTERNATIVE ANTIHYPERTENSIVE
hypoglycemic agents.
DRUGS
• Control of blood glucose levels during the
• Nifedipine
preconception period and early first
trimester is of utmost importance to decrease – Nifedipine (Procardia, Adalat) has
the risk of congential malformations. been used in doses of 10 mg for
acute treatment of severe
HYPERTENSION
hypertension during pregnancy
• Hypertensive disease occurs in 5% to 10% because it can be given orally.
of all pregnancies and is a major cause of
maternal and perinatal morbidity and
mortality. 47 DISORDERS RELATED TO THE
MENSTRUAL CYCLE
• Hypertension in pregnancy is defined as a
systolic BP ≥140 mm Hg or a diastolic BP
≥90 mm Hg on two separate occasions at
least 6 hours apart. 48 THE TRANSITION THROUGH
MENOPAUSE
ANTIHYPERTENSIVE DRUG THERAPY
• The goal of antihypertensive therapy for
SECTION 12 ENDOCRINE DISORDERS
women with chronic hypertension during
pregnancy is to minimize the risks to the 49 THYROID DISORDERS
mother of an elevated BP without
compromising placental perfusion. 50 DIABETES MELLITUS
METHYLDOPA SECTION 13 EYE DISORDERS
51 EYE DISORDERS
• Methyldopa (Aldomet) is a centrally-acting
SECTION 14 NEUROLOGIC
α-agonist that decreases sympathetic
outflow to decrease BP. DISORDERS
52 HEADACHE
• It is the antihypertensive most commonly
used for chronic treatment of hypertension
in pregnancy. 53 PARKINSON’S DISEASE AND
ALTERNATIVE ANTIHYPERTENSIVE DRUGS OTHER MOVEMENT
DISORDERS
• Labetalol
– Labetalol (Trandate) is the second
any disorder associated with two or more
most commonly used drug to treat features of tremor, rigidity, bradykinesia, or
severe hypertension during postural instability.
pregnancy.
CAUSES
– It should be administered IV in
increasing doses of 20, 40, and 80 - caused by a loss of nerve cells in the
mg every 10 minutes to a cumulative part of the brain called the substantia
dose of 300 mg or until the diastolic nigra
pressure is <100 mm Hg. - Genetics
 - Environmental factors
- medication (drug-induced
parkinsonism)
- other progressive brain conditions
- cerebrovascular disease
PREVENTIVE MEASURES
- Avoid using herbicide and pesticides
- Eat vegetables (dark green vegetables)
- Incorporate Omega 3 fatty acids to
your diet
- Regular exercise
MEDICATION/ TREATMENT
1. Carbidopa levodopa
Levodopa is combined with carbidopa
(Lodosyn), which protects levodopa from
early conversion to dopamine outside your
brain. This prevents or lessens side effects
such as nausea
2. Dopamine Antagonist
Unlike levodopa, dopamine agonists don't
change into dopamine. Instead, they mimic
dopamine effects in your brain.
3. Mao B Inhibitors
They help prevent the breakdown of brain
dopamine by inhibiting the brain enzyme
monoamine oxidase B (MAO B). This
enzyme metabolizes brain dopamine.
4. COMT Inhibitors
This medication mildly prolongs the effect
of levodopa therapy by blocking an enzyme
that breaks down dopamine.
54 SEIZURE DISORDERS
A seizure is a sudden, uncontrolled electrical
disturbance in the brain
CAUSES :
brain injury, such as trauma, stroke, brain
infection, or a brain tumor.
PREVENTIVE MEASURES
- Get plenty of sleep each night
- Learn stress management and
relaxation techniques.
- Avoid drugs and alcohol.
- Take all of your medications as
prescribed by your physician
55 CEREBROVASCULAR DISORDERS
- refers to a group of conditions that can lead
to a cerebrovascular event, such as a stroke.
Transient ischemic attack
• Describes the clinical condition in
with the patient experiences a
temporary focal neurologic deficit
such as speech, aphasia, weakness or
paralysis of a limb or blindness
Cerebral infarction
• A permanent neurologic disorder
characterized by symptoms similar to
TIA.
• Caused by the death of neurons in the
focal area of the brain
Cerebral haemorrhage
• Involves escape of blood from blood
vessels into the brain and its
surrounding structures.
CAUSES
- Damage to blood vessels
- Low oxygen supply
- Inflammation in the arteries
PREVENTIVE MEASURES
quitting smoke, getting regular physical
exercise, eating a heart-healthy, low-fat diet,
avoiding obesity, controlling blood pressure
and hypertension, lowering cholesterol, and
avoiding chronic stress or anger.
MEDICATION/ TREATMENT
1. CAROTID ENDARTERECTOMY
Carotid endarterectomy (CEA) is a
common surgical procedure for
correcting atheromatous lesions
responsible for causing a TIA.
2. ASPIRIN
Because platelets play a key role in the
formation of atheromatous clots various
antiplatelet drugs, such as aspirin,
sulfinpyrazone, dipyridamole,
ticlopidine, and clopidogrel have been
tried to prevent ischemic strokes.
3. DIPYRIDAMOLE
Two pharmacologic actions of
dipyridamole prompted investigations
into its use in preventing TIAs and
ischemic stroke. Dipyridamole weakly
inhibits platelet aggregation and platelet
phosphodiesterase and has potential
vasodilating properties through its
inhibition of adenosine uptake in
vascular smooth muscle.
4. TICLOPIDINE
Ticlopidine (Ticlid) is an antiplatelet
agent approved only for the prevention of
TIA and stroke for patients with a prior
cerebral thrombotic event.
SECTION 15 INFECTIOUS
DISEASE
56 PRINCIPLES OF INFECTIOUS
DISEASES
Approaching the problem
• The proper selection of antimicrobial
therapy is based on several factors:
• establish the presence of infection
• site of infection, signs and symptoms must
be identified
• laboratory tests
• drug selection
• dosage must be based on patient's size, age,
site of infection.
A. Establishing the presence of an infection
B. Establishing the severity of an infection
C. Problems in the diagnosis of an infection
-confabulating variables (major surgery, acute
myocardial infarction), initiation of corticosteroids
can increase WBC
-drug effects (dexamethasone can reduce
inflammation)
D. Establishing the site of an infection
-most likely sources of infection
-respiratory-bronchitis (H. influenzae)
-skin and soft tissue- cellulitis (E. coli)
E. Determining likely Pathogens
-(bacteria, fungi,viruses, chlamydiae, rickettsiae,
mycoplasmas, spirochetes,mycobacteria)
F. Microbiologic tests and susceptibility of
organisms
- Culture and susceptibility
1. Disk diffusion (Kirby-Bauer)
-uses agar plate
- if antimicrobial is active against pathogen, a zone
of inhibition is observed
2. Broth dilution
-involves placing bactrial inoculum into test tubes
-cloudy- bacterial growth occured
G. Antimicrobial dosing
-site of infection requires differing dosage
requirements
-anatomic and physiological barriers (penetration
into CNS requires high doses)
-route of elimination (eliminated via renal or
norenally)
-patient age
eg. aminoglycosides
57 ANTIMICROBIAL PROPHYLAXIS
FOR SURGICAL PROCEDURES
• Prophylactic antibiotics are used in surgical
procedures and account substantial antibiotic
use in many hospitals
• reduce the prevalence of postoperative
wound infection at or around the surgical
site
• antimicrobial prophylaxis should be given
for surgical procedures: a) with high rate of
infection b) involving implantation c)
infections that would have catastrophic
consequences
Wound Classifaction
1. clean- no acute inflammation or entry into
GI, respiratory
2. clean-contaminated- elective, controlled
opening of GI, respiratory, biliary
3. contaminated- penetrating trauma, major
technique break or major spillage from the
GI tract
4. Dirty- penetrating trauma
Suggested Prophylactic Antimicrobial regimens
1. Clean
cardiac-S. aureus-cefazolin-1g IV
thoracic-S. aureus-cefazolin-1g IV
2. Clean-contaminated
head and neck- S. aureus-cefazolin- 2g IV
colorectal- gram-negative enterics- oral
neomycin-erythromycin- 1g each at 1pm,
2pm and 11pm day before the surgery
appendectomy(uncomplicated)-B. fragilis-
cefoxitin-1-2g IV
Principles of surgical antimicrobial
1. Decision to use antimicrobial prophylaxis
- selected prophylactic agent should be
directed against infecting organisms but not
to eradicate every potential pathogen
2. Timing of antimicrobial administration
- for maximal efficacy, an antibiotic should
be present in therapeutic concentrations at
the incision site as early as possible during
decisive period and until wound is closed
3. Route of administration
- oral admin is not recommended because of
unreliable or poor absorption
- oral regimen against fecal flora is 1g each
of nonabsorbable neomycin sulfate and
erythromycin base
-parenteral regimens are effective in
colorectal procedures
4. Duration of adminstration
- the shortest effective prophylactic course
of antibiotics should be used
- postoperative doses after wound closure
are usually not required and may increase
resistance
 5. Selection of an Antimicrobial Agent
- cefazolin is considerably less expensive
than broader-spectrum agents and is
currently recommeded by the American
College of Obstetricians and Gynecologists
58 CENTRAL NERVOUS
SYSTEM INFECTIONS
Meningitis
meninges- layers of tissue that separates the
skull and the brain
meningitis- acute inflammation of the
meninges caused by virus or bacteria
Route of entry in the CNS
• skull or back bone fractures (trauma)
• medical procedures
• along peripheral nerves
• blood or lymphatic system
Etiology
The causes can be classified into:
-bacterial infections
-viral infections
-fungal infections
Pathophysiology
• bacteria enters blood stream/trauma
• enters mucosal cavity
• breakdown of normal barries
• crosses blood brain barrier
• proliferates in the CSF
• inflammation of the meninges
• increase in ICP
Bacterial meningitis
• aka septic meningitis
• extremely serious that requires immediate
care
• can lead to permanent damage or brain
disability
• spreads by: coughing or sneezing
• treatment available: antibiotics as per
causative agent
• causative agents: S. pneumonia, N.
meningitis, H. influenza
Tubercular meningitis
• caused by M. tuberculosis
• infection begins in the lungs
• progresses very slow and symptoms are
vague
Viral meningitis
• aka aseptic meningitis
• more common than bacterial meningitis and
less serious
• less likely to have permanent damage
• treatment: no specific treatment avalable
• patients recover on their own
• causative agents: enterovirus, adenovirus,
arbovirus
Fungal meningitis
• less common than the two infections
• rare in healthy people but it is more likely in
persons who have impaired immune system
• risk factors: systemic infections, tobacco
use, over crowding
Clinical manifestations
• Infants: fever, vomiting, high pitch moaning
cry, neck retraction, pale and blotchy
complexion
• Adults: stiff neck, headache, fever,
vomitting, joint pain
Medical management
 • Bacterial meningitis • caused by: S. viridans or enterococcus
- third generation cefalosporins such as epidemiology and etiology
cefotaxime or cetriaxone
• mean male-to-female ratio is 1.7:1
-vancomycin is added in case of resistance
Risk factors
-dexamethasone
• presence of prosthetic heart valve (highest
-fluid therapy risk)
-phenytoin for seizure management • previous endocarditis
• Tubucular meningitis: • hypertrophic cardiomyopathy
-are started with Rifampicin, Pyrazinamide and • presence of IVDA
Streptomycin
• increased longevity leads to more
-Second line drugs: Aminoglycosides, degenerative valvular disease, placement of
Fluoroquinolones prosthetic valves and increased exposure to
nosocomial bacteremia
-conventional therapy is given for 6-9 months
PROSTHETIC HEART VALVES
- in children BCG vaccine offer protective effect
Onset

59 ENDOCARDITIS within 2 months of surgery early and usually

hospital acquires
INFECTIVE ENDOCARDITIS
12 months post surgery late onset and usually
• Inflammation of the endocardium, the community acquired
membrane lining the chambers of the heart
and covering the cusps of the heart valves NOSOCOMIAL INFECTIVE
ENDOCARDITIS
CHARACTERISTICS
• half of the cases is linked to intravascular
• vegetation devices
- pathological lesion composed of platelets, • other sources: surgical wound infection
fibrin, microorganisms and inflammatory cells
ETIOLOGICAL AGENTS
• Acute/Subacute-chronic
1. Streptococci
• by organism
- S. viridans/ alpha-hemolytic streptococci
native valve or prosthetic valve like S. mitis, S. sanguis, S. oralis
Acute Endocarditis -S. bovis
• toxic progression 2. Enterococci
• progressive valve destruction- days to weeks -E. faecalis and E. faecium
• Commonly caused by S. aureus -associated with GIT procedures
Sub-acute 3. Staphylococci
• mild toxicity -most common cause of INFECTIVE
• weeks to months ENDOCARDITIS
 -S. aureus: Native valves and acute TTE
endocarditis
• TRANS- THORACIC
-Coagulase-negative staphylococci: ECHOCARDIOGRAPHY
Prosthetic valve endocarditis
-obesity, COPD, and chest wall deformities
PATHOGENESIS
TOE
• Altered valve surface
• Transesophageal echo
• deposition of platelets and fibrin
-evaluate myocardial invasion
• bacteremia- attaches to platelet-fibrin
-more cost effective in those with S. aureus
deposits
COMPLICATIONS
-covered by more fibrin
• Congestive heart failure-valvular damage,
-protedted from neutrophils
higher mortality
-division of bacteria
• Systemic emboli
-mature vegetation
GOALS OF THERAPY
SITE OF INFECTION
• Eradicate infxn
• Aortic valve more common than mitral
• treat sequel of destructive intra-cardiac and
• Aortic extra-cardiac lesions
- dynfxn of the valve THERAPY
MItral • Antimicrobial therapt
- dysfxn by rupture of chordae tendineae • Surgery
CLINICAL MANIFESTATIONS ANTIBIOTICS
• fever • Penicillin G- 12-18 million units/ day IV in
6 doses
• anorexia. weight loss, night sweats
• amoxicillin 4-6 doses per day
• heart murmur
• ceftriaxone with gentamycin/ netilmicin
• petechiae on the skin
in beta lactam allergic px
• oral mucosa
• Janeway lesions
-vancomycin

• Splinter hemorrhages INDICATIONS FOR SURGERY

• Osler nodes • HF
Investigations • uncontrolled infection
• blood culture • prevention of embolism
• TTE/TOE
• ESR/CRP

60 RESPIRATORY TRACT
INFECTIONS
61 TUBERCULOSIS
History
Tuberculosis is an ancient disease, and
evidence of TB dates back as far as
prehistoric times with evidence being found
in pre-Columbian and early Egyptian
remains. However, TB did not become a
problem until the 17th and 18th centuries
when crowded living conditions of the
industrial revolution contributed to its
epidemic numbers in Europe and the United
States.
Early physicians referred to Tb as Phthisis,
derived from the Greek term for wasting,
because its clinical presentation consisted of
weight loss, cough, fevers, and hemoptysis.
1882- Robert Koch isolated and cultured
Mycobacterium tuberculosis and
demonstrated its infectious nature.
Etiology
Tuberculosis is caused by M. tuberculosis,
an aerobic, non-spore-forming bacillus that
resists decolorization by acid alcohol after
staining with basic fuchsin. For this, season
the organism is often referred to as an acid-
fast bacillus (AFB). It is also different from
other organisms in that it replicates slowly
once every 24 hours instead of every 20 to
40 minutes as do some other organisms. M.
tuberculosis thrives in environments where
the oxygen tension is relatively high, such as
the apices of the lung, the renal parenchyma,
and the growing ends of bones.
Pathogenesis
Latent infection vs Active disease
Latent infection occurs when the tubercle
bacilli are inhaled into the body. After
inhalation, the droplet nuclei containing M.
tuberculosis settle into the bronchioles and
alveoli of the lungs.
Persons with latent TB infection are not
infectious and cannot spread TB infection to
others.
A person with Latent TB infection
 Usually has a skin test or blood test
result indicating TB infection
 Has a normal chest x-ray and a
negative sputum test
 Has TB bacteria in his/her body that
are alive, but inactive
 Does not feel sick
 Cannot spread TB bacteria to others
 Needs treatment for latent TB
infection to prevent TB disease;
however, if exposed and infected by a
person with multidrug-resistant TB or
extensively drug-resistant TB,
preventive treatment may not be an
option.
 Active disease
 In some people, TB bacteria
overcome the defenses of the immune
system and begin to multiply,
resulting in the progression from
latent TB infection to TB disease.
Some people develop TB disease soon
after infection, while others develop
GENERAL SYMPTOMS OF TB  80% effective in preventing TB for
DISEASE 15 years
 Unexplained weight loss  More effective against complex forms
of TB in children
 Loss of appetite
 Of limited effectiveness in people
 Night sweats
over the age of 35
 Fever
 Early diagnosis
 Fatigue
early diagnosis and treatment is the
 Chills most effective way to prevent the spread
 TB disease later when their immune of tuberculosis.
system becomes weak.  Managing you environment
THE SYMPTOMS OF TB OF THE As TB is an airborne infection, TB
LUNGS bacteria are released into the air when
 Coughing for 3 weeks or longer someone with infectious TB coughs or
sneezes. The risk of infection can be
 Hemoptysis (coughing up blood) reduced by using a few simple
 Chest pain precautions:

DIAGNOSTICS:  Good ventilation

 Mantoux test (purified protein  Natural light

derivative test) measure the  Good hygiene
induration. It reveals only the
exposure of TB. TREATMENT

 Direct sputum smear microscopy- Drugs use in Tuberculosis

primary diagnostic tool First line drugs
 Chest X-ray severity of lung lesions  Rifampin
brought about by the bacteria.
 Isoniazid
PREVENTIVE MEASURES
 Pyrazinamide
 BCG vaccination
 Ethambutol
Bacille Calmette-Guerin is a live
 Streptomycin
vaccine against tuberculosis. The vaccine
is prepared from a strain of the weekened Alternative drug
bovine tuberculosis bacillus,
 Amikacin
Mycobacterium bovis.
 Ciprofloxacin
BCG is:
  Ethionamide
 P-aminosalycylate
 Rifampin
MOA: inhibits DNA-dependent and RNA
polymerase (encoded by rpo gene)
Resistance MOA: resistance via changes in
drug sensitivity of the polymerase after
emerges rapidly if the drug is used alone.
Toxicity:
 Commonly cause light chain
proteinuria and may impair antibody
response
 Strongly induces liver drug
metabolizing enzymes and enhances
the elimination rate of many drugs
including:
 Anticonvulsants
 Contraceptive steroids
 Cyclosporine
 Ketoconazole
MOA: inhibition of the synthesis of
myolic acid, essential components of
mycobacterium cell walls.
Resistance MOA:
 High level resitance is associated with
deletion in the KatG gene that codes
for a catalase-peroxidase involved in
the bio activation of INH.
 Low level resistance occurs via
deletion in the inhA gene that encodes
the target enzyme an acyl carrier
protein reductase.
Toxicity:
 Neurotoxic effects are common and
include peripheral neuritis,
restlessness, muscle twitching and
insomnia. These effects can be
alleviated by administration of
Pyridoxine ( vitamin B6 ) 25-50 mg/d,
orally
 Hepatotoxic
 Inhibit the hepatic metabolism of
drugs

 Methadone  Carbamazepine

 Terbinafine  Phenytoin

 Warfarin  warfarin

 Rash  Pyrazinamide

 Nephritis  MOA: bacteriostatic action appears to

require metabolic conversion via
 Thrombocytopenia pyrazinamide's (encoded by the pncA
 Flu like syndrome with intermittent gene) present in M. tuberculosis.
dosing  Resistance MOA: resistance occurs
Isoniazid via mutations in the gene that encodes
enzymes involved in the bio
activation of pyrazinamide and by
 increased expression of drug efflux
systems.
toxicity
 Approximately 40% of patients
develop nongouty polyarthralgia
 Hyperuricemia occurs commonly but
is usually asymptomatic
 Other adverse effects are
 Myalgia
 GI irritation
 Maculopopular rash
 Hepatic dysfunction
 Porphyria
 Photosensitivity reactions
 Should be avoided in pregnancy
 Possible retinal damage (from
prolonged use as high doses)
 Other adverse effects includes
 Headache
 Confusion
 Hyperurecemia
 Peripheral neuritis
ALTERNATIVE DRUG
 Amikacin is indicated for the
treatment of tuberculosis suspected to
be cause by streptomycin resistant or
multidrug resistance.
 Ciprofloxacin and ofloxacin are often
active against strains of m.
tuberculosis resistance to first line
agents.

 Ethambutol  Ethionamide is a congener of INH,

but cross resistance does not occur.
 MOA: inhibits arabinosyltranferases
(encoded by the embCAB operion) Standard regimens
involved in the synthesis of  Initial 3 drug regimen (R, I, P)
arabinogalactan, a component of
 If the organism are fully susceptible
mycobacterial cell walls.
pyrazinamide can be discontinued
 Resistance MOA: resistance occurs after 2 months with a 2 drug regimen.
rapidly via mutations in the emb gene
Alternative regimens
if the drug is used alone.
 INH + Rifampin for 9 months
Toxicity:
 INH + ethambutol for 18 months
 The most common adverse effectsd
intermittent (2-3 x weekly) high-dose
are dose dependent visual
disturbances  4drug regimen are also effective
 Decreased visual acuity
 Red-0green color blindness
 Optic neuritis
 • Shigella species
62 INFECTIOUS DIARRHEA
• Salmonella species
• Clostridium difficile
Infectious diarrhea is caused by th ingestion
of food or water contaminated with • Shiga toxin-producing E.coli (STEC)
pathogenic microorganism or their toxins. • Entamoeba histolytica
Diarrhea is often defined as three or more
episodes of loose stool or any loose with
63 INTRA-ABDOMINAL INFECTIONS
blood during a 24-hour period. PERITONITIS
Classification of infectious diarrhea
- Inflammation of the peritoneum, the
Noninflammatory diarrheas are generally a tissue that lines that lines the inner
less severe illness in which patients present wall of the abdomen and covers and
with nonbloody, watery stools; patients are supports most of your abdominal
afebrile and without significant abdominal organs. Peritonitis is usually caused
pain. by infection from bacteria and fungi.
- If left untreated, peritonitis can
Noninflammatory diarrheas are typically
rapidly spread into the blood (sepsis)
caused by:
and the other organs.
• Rotaviruses
Symptoms of peritonitis
• Noroviruses
• Poor appetite
• Staphylococcus aureus
• Nausea
• Bacillus cereus
• Dull abdominal ache
• Clostridium perfringens
• Abdominal tenderness or distention
• Cryptosporidium parvum
• Chills
• Giardia lamblia
• Fever
Inflammatory diarrheas are generally a
• Fluid in the abdomen
more severe illness in which patients
present with bloody diarrhea, severe • Difficulty in passing gas or having a
abdominal pain, and fever, and bowel movement
examination of stool specimens reveals
• Vomiting
the presence of large numbers of fecal
leukocytes. Two type of peritonitis:
Inflammatory diarrheas are caused by • Primary spontaneous peritonitis, an
invasive pathogens including, infection that develops in the
peritoneum.
• Campylobacter jejuni
 • Secondary peritonitis, which usually
develops when an injury or infection
in the abdominal cavity allows
infectious organisms into the
peritoneum.
Most common risk factors for primary
spontaneous peritonitis include:
1. Liver disease with cirrhosis such
disease often causes a buildup of
abdominal fluid (ascites) that can
become infected.
2. Kidney failure getting peritoneal
dialysis.
Common cause of secondary peritonitis
include:
1. a ruptured appendix, diverticulum or
stomach ulcer
2. Digestive disease such as crohn’s
disease and diverticulitis.
3. Pancreatitis
4. Pelvic inflammatory disease
5. Perforations of the stomach, intestine,
gallbladder or appendix.
Diagnostics test:
1. Blood and urine tests
2. Imaging studies such as x-rays and
computerized scans.
3. Exploratory surgery
-
64 URINARY TRACT
INFECTIONS
Is an infection of the body’s urinary
system.
- It is an infection caused by microbes.
urinary tract is made up of:
 o Kidneys
o Ureters
o Bladder
o Urethra
o Most UTIs only involve the urethra
and bladder, in the lower tract.
o UTIs can involve the ureters and
kidneys, in the upper tract. Although SYMPTOMS
upper tract UTIs are more rare than Urinary tract infection don’t always
lower tract UTIs, they’re also usually cause signs and symptoms, but when
more severe. they do they may include:
‐ A strong, persistent urge to urinate
CAUSES:
‐ A burning sensation when urination
- Typically occur when bacteria enter ‐ Passing frequent, small amounts of
the urinary tract through the urethra urine
and begin to multiply in the bladder. ‐ Urine that appears red, bright pink or
- When that happens, the bacteria take cola-colored – a sign of blood in the
hold and grow into a full-blown urine
infection in the urinary tract. ‐ Strong-smelling urine
Most common UTIs occur mainly in the ‐ Pelvic pain, in women – especially in
women and affect the bladder and urethra the center of the pelvis and around the
area of the pubic bone
Infection of the bladder (cystitis)
PREVENTIVE MEASURES
This type of UTI is usually caused by
Escherichia coli.
However, sometimes other bacteria
are responsible.
Infection of the urethra (urethritis)
This type of UTI can occur when GI
bacteria spread from the anus to the urethra.
Also, because the female urethra is
close to the vagina and sexually transmitted DIAGNOSIS
infections can cause urethritis. o Analyze a urine sample
Herpes, gonorrhea, chlamydia and • urinalysis
mycoplasma
o Growing urinary tract bacteria in the
lab
• Urine culture
o Creating images of your urinary tract
• CT scan
• MRI
o Using scope to see inside your bladder
• Cystoscopy
TREATMENT
Simple infection
Drugs that are commonly recommended:
o Trimethorprim/sulfamethoxazole
o Fosfomycin (monurol)
o Nitrofurantoin (macrodantin,
macrobid)
o Cephalexin
o Ceftriaxone
Severe infection
May need treatment with IV antibiotics
in the hospital
Frequent infections
o Low-doe antibiotics, initially for six
month but sometimes longer
o Self-diagnosis and treatment, if you
stay in touch with your doctor
o A single doe of antibiotic after sexual
intercourse if your infections are
related to sexual activity
o Vaginal estrogen therapy if you’re
posstmenopausal
65 SEXUALLY TRANSMITTED
DISEASES
also called sexually transmitted
infections, or STIs.
- are infections spread from person to
person during sex
- Sometimes these infections can be
transmitted nonsexually
- From mother to infant during
pregnancy or childbirth
- Blood transfusion or shared needle
- Can be through vaginal, oral, or anal
or close intimate contact
Causes:
× Bacteria
× gonorrhea
× Syphilis
× chlamydia
× Parasites
× trichimoniasis
× Viruses
× Human papillomavirus
× Genital herpes
× Human immunodeficiency
virus
Types of sexually transmitted disease:
HIV (human immunodeficiency virus)
- is the virus that causes AIDS.
- HIV attacks the immune system by
destroying CD4 positive (CD4+) T
cells
- The destruction of these cells leaves
people infected with HIV vulnerable
 to other infections, diseases and other Type 1 (HSV-1) - cold sores
complications
Type 2 (HSV-2) – genital
- Viral STD herpes
Common symptoms:
× Flu-like illness - It causes herpetic sores which are
painful blisters
× Swollen lymph nodes
Common symptoms:
× Skin rash
× Fever & flu-like symptoms
Many people do not notice symptoms
× Muscle aches
Treatments: (ANTIRETROVIRUS
TREATMENT/ ART) × Painful urination
× TDF (tenofivir) × Tingling, burning or itching sensation
in the area where the blisters are
× 3TC (lamivudine) or FTC
(emitricitabine) Treatments:
× EFV (efavirenz) There is no cure for Herpes.
Chlamydia However, there are some medication to
treat or prevent symptoms:
Causative agent: Chlamydia trachomatis
- Acyclovir (Zovirax)
- It can cause cervicitis in women and
urethritis and proctitis in both men - Famciclovir (Famvir)
and women.
- Valacyclovir (Valtrex)
- Bacterial STD
GONORRHEA
Common symptoms:
Causative agent: Neisseria gonorrhoeae
× Discharge from the vagina, penis or bacterium
anus
- infects the mucous membranes of the
× Burning when urinating reproductive tract, including:
Often there is no symptoms Cervix
Treatments: Uterus
Azithromycin (single or large dose) Fallopian tubes (women)
Doxycycline (twice per day for 1 week) Urethra (women and men)
GENITAL HERPES - can also infect the mucous
membranes of the mouth, throat, eyes,
Causative agent: Herpes simplex viruses
and rectum
Common symptoms: Urine sample
× Discharge from the vagina, penis or Fluid sample
anus
× Burning when urinating
Women often do not notice symptoms
Men may have symptoms in the penis
Treatments:
There is no cure for Herpes.
However, there are some medication to treat 66 OSTEOMYELITIS AND SEPTIC
or prevent symptoms: ARTHRITIS
- Acyclovir (Zovirax) 67 TRAUMATIC SKIN AND SOFT
TISSUE INFECTIONS
- Famciclovir (Famvir)
- Valacyclovir (Valtrex) 68 PREVENTION AND
TREATMENT OF INFECTIONS IN
NEUTROPENIC CANCER
PREVENTIVE MEASURES PATIENTS
× Abstain
69 PHARMACOTHERAPY OF
× Stay with one uninfected partner HUMAN
× Avoid vaginal or anal intercourse with IMMUNODEFICIENCY VIRUS
new partners until you have both INFECTION
been tested for STIs
70 OPPORTUNISTIC INFECTIONS
× Practice safer sex every time you have IN HIV-INFECTED
sex PATIENTS
× Get vaccinated early, before sexual 71 FUNGAL INFECTIONS
exposure
72 VIRAL INFECTIONS
× Don’t drink alcohol excessively or use
drugs 73 VIRAL HEPATITIS
× Consider male circumcision 74 PARASITIC INFECTIONS

× Consider truvada 75 TICK-BORNE DISEASES

DIAGNOSIS SECTION 16 PSYCHIATRIC
DISORDERS
Blood sample
77 SLEEP DISORDERS
SS : Consistent failure to get enough sleep 2. Prenatal Damage
or restful sleep * Malnutrition
Consistently feeling tired upon waking &/or * Viruses
waking with a headache
3. Environment
Chronic fatigue, tiredness, sleepiness during
the day * Family Stress

Struggling to stay awake while driving or * Poor Social Interactions

doing something passive, e.g. watching TV
Difficulty concentrating at work or school
Slowed or unusually delayed response to
stimuli or events
Difficulty remembering things or controlling
emotions
Frequent urge to nap during the day
Snoring or ceasing to breathe during sleep
* Infections or Viruses at an early age
* Trauma at an early age
4. Neurotransmitters (Biological)
* too much dopamine, low levels of
serotonin and glutamate
5. Brain Abnormalities (Biological)
* reduced number of neurons
* enlarged ventricles

78 SCHIZOPHRENIA * thalamus abnormalities

₋ debilitating and emotionally Characteristic Symptoms

devastating illness with long-term At least two of the following, each present
impact on patients’ lives. for a significant portion of time during a 1-
month period :
₋ most severe expression of 1. Delusions
psychopathology, encompassing 2. Hallucinations
significant disruptions of thinking, 3. Disorganized speech
perception, emotion, and behavior. 4. Grossly disorganized or catatonic
₋ usually a lifelong psychiatric behavior
disability. 5. Negative symptoms

 affects men and women with equal
frequency, there are differences in the
age of onset and course of illness.
 during late adolescence or early
adulthood.
CAUSES
Note: Only one “A symptom” is required if
delusions are bizarre or
hallucinations consist of a voice keeping up
a running commentary
on the person’s behavior or thought, two or
more conversations with
each other.

1. Genetics – “runs in the family” TYPES

 1. Disorganized Classification of Mood Disorders
* lack of emotion
A. Depressive Disorders
* disorganized speech 1. Major Depressive Disorder, Single
* silly/childlike behavior Episode
2. Major Depressive Disorder, Recurrent
* makes no sense when talking 3. Dysthymic Disorder
2. Catatonic 4. Depressive Disorder Not Otherwise
Specified
* waxy flexibility
Individuals must possess at least five
* reduced movement symptoms, one of which is either
* rigid posture depressed mood. The other seven
symptoms are as follows:
* sometime too much movement
1. Change in appetite
3. Paranoid 2. Change in sleep
* strong delusions 3. Low energy
4. Poor concentration (or difficulty making
* strong hallucinations decisions)
TREATMENT 5. Feelings of worthlessness or inappropriate
guilt
6. Psychomotor agitation or retardation
Schizophrenia is a chronic disease for which
7. Recurrent thoughts of suicide
there is no
cure. Selected Medications That May Induce
Depression
Pharmacotherapy can reduce symptoms to
improve social and cognitive functions;
however, patients have multiple relapses and Cardiovascular Agents
experience residual symptoms throughout β-blockers
their lives. Clonidine
Methyldopa
Treatment can decrease acute symptoms,
Reserpine
decrease the frequency and severity of
Central Nervous System
psychotic episodes, and optimize
Agents
psychosocial functioning between episodes.
Barbiturates
Benzodiazepines
Chloral hydrate
Ecstasy (MDMA)
79 MOOD DISORDERS I: MAJOR Ethanol
DEPRESSIVE
Hormonal Agents
DISORDERS
Anabolic steroids
Corticosteroids Malignancies (various)
Gonadotropin-releasing hormone Migraine headaches
Progestins Rheumatoid arthritis
Tamoxifen Systemic lupus erythematosus
Others
NON DRUG THERAPIES
Efavirenz
Interferon Most experts now advocate a three-pronged
Isotretinoin approach to relieving and preventing
depressive symptoms, involving
Mefloquine
Levetiracetam (a) psychotherapy
cognitive – behavioural therapy
Selected Medical Conditions That May Interpersonal therapy
Mimic Depression Psychoanalytic
Central Nervous System Psychodynamic therapy
Alzheimer disease
Cerebrovascular accident
Epilepsy (b) somatic interventions
Multiple sclerosis
Parkinson disease ECT ( Electroconvulsive therapy )

Cardiovascular - Safe, rapid acting highly effective

Cerebral arteriosclerosis
Congestive heart failure
Myocardial infarction
Endocrine
Addison disease
Diabetes mellitus (types I and II)
Hypothyroidism
Women’s Health
Premenstrual dysphoric disorder
Antepartum/postpartum
Perimenopause
Other
Chronic fatigue syndrome
Chronic pain syndrome(s)
Fibromyalgia
Irritable bowel syndrome
therapeutic intervention that continues to
suffer, from a poor public shaming
-done under general anesthesia in which
small electric currents are passed through
the brain
TMS (Trans magnetic stimulation)
- non-invasive procedure involving the
application of
an electrical stimulus across the scalp, which
ultimately generates an electrical field in the
cerebral cortex
(c) lifestyle adjustments
- Reverse unhealthy or destructive lifestyle
habits
- Alcohol, recreational drug use, and
excessive caffeine consumption should be
minimized in patients suffering from
depression or anxiety disorders.
- Sleep habits should be evaluated and
improved to ensure optimal rest.
- Dietary factors should be modified to
promote diverse, balanced, and
nutritional eating habits
- Increased physical activity and sustained
cardiovascular exertion can impart a variety
of health benefits.
80 MOOD DISORDERS II: BIPOLAR
DISORDERS
81 ATTENTION DEFICIT
HYPERACTIVITY DISORDER IN
CHILDREN, ADOLESCENTS, AND
ADULTS
INATTENTION FACTOR
1. careless mistakes or inattention to
detail
2. reduce attention span
3. poor listener
4. cannot follow instructions and does
not complete tasks
5. difficulty organizing tasks and
activities
6. avoid and/or dislikes chores or
homework
7. loses things needed for tasks and
activities
8. easily distracted by extraneous stimuli
9. forgetful in daily activities
HYPERACTIVITY/ IMPULSIVITY
FACTOR
• HYPERACTIVITY
1. fidgets with hands/ feet or
squirms in chair
2. cannot remain seated in the
classroom
3. uncontrollable/ inappropriate
restlessness
4. difficulty in engaging in play or
leisure activities quietly
5. often on the go and appearing
driven by a motor
6. excesssive talking
• IMPULSIVITY
7. blurts out answer prior to completion
of question
8. difficulty waiting in turn
9. interrupts or intrudes on others
• ADHD is classified into 3 subtypes:
hyperactive-impulsive, innattentive or
combined
• approx 2.5 times more frequent
among males than females
• high rate on conduct disorder,
oppositinal defiant disorder,
depression, major affective disorder
and anxiety disorders including OCD
and Tourette syndrome.
• Diagnosis:
• exclude: head injuries, absence
seizures, cerebral infection,
substance abuse,
 hyperthyroidism, anxiety by a desire (but not a
disorders and mood disorders. compulsion) to continue using
the drug, no tendency to
• physical examination,
increase the dose, and an
neurological examination,
absence of physical addiction
social, family, school and
despite some degree of
medical history
physiological dependence.
PHARMACOTHERAPY
2 Groups for Substance-Related Disorders
• CNS stimulant or psychostimulant
1. Substance use disorders
medications are the DOC
- distinguishing between substance
• tricyclic antidepressants (TCAs)
dependence and substance abuse
• atomexetine
2. Substance-induced disorders
• bupropion
- intoxication, withdrawal
• clonidine
URINE SCREENING AND ITS PITFALLS
• norepinephrine and/or dopamine
• exercise and hydration
agonists
• enhancing secretion
82 EATING DISORDERS • drinking vinegar or cranberry juice
SECTION 17 SUBSTANCE ABUSE • taking vitamin C
83 DRUG ABUSE • taking saunas
• Physical addiction or dependence • buying clean urine from a drug-free
individual
• repeated administration of a
drug which causes an altered • adding bleach, isopropanol or salt to
physiologic state urine sample
(neuroadaptations)
• dehydration
• Physiological addiction or
• adding water to specimen
Psychological dependence
I. OPIOIDS
• maladaptive pattern of
substance use leading to a. Heroin
clinically significant b. Rx drugs
impairment or disease.
II. Sedative-Hypnotics
• Habituation
a. Ethanol
• a state of either chronic or
periodic drug use characterized b. Benzodiazepines
 c. Carisoprodol
d. GHB
III. CNS stimulants
a. Cocaine
b. Amphetamines
IV. Dissociative Drugs
a. Phencyclidine
b. Ketamine
c. Dextromethorphan
V. Hallucinogens
a. LSD
b. MDMA
VI. Marijuana
VII. Inhalants
OPIOIDS
HEROIN
• Addiction: noticeably opioid
physical dependence
• Withdrawal: (after 6-12 hrs)
anxiety, hyperactivity,
restlessness and insomnia;
(after 48-72 hrs) anorexia,
nausea, vomiting abdominal
cramps and diarrhea
• During withdrawal: heart rate
and BP may elevate, marked
weight loss, dehydration,
cardiovascular collapse
• The more dramatic symptoms
of heroin withdrawal subside
after 7-14 days of abstinence
without treatment; however, a
return to complete physiologic
equilibrium may require
months or longer; seldom life-
threatening
• Iatrogenic dependence: after 2-
10 days
• Overdose Treatment: airway
management, cardiorespiratory
support and opioid reversal
with naloxone (IV, IM or SC)
• Treatment of Opioid
Dependence: detoxification
programs, methadone
(treatment of choice)
SEDATIVE-HYPNOTICS
Ethanol
• most widely abused substance
Benzodiazepines
• prototypical sedative-hypnotic
drug of abuse
GHB (Gamma-hydroxybutyric acid)
• a putative neurotransmitter
abused for its euphoric and
sedative-hypnotic effect
Carisoprodol
• a nonscheduled skeletal muscle
relaxant, has an active
metabolite meproamate with
known abuse potential.
Txn of withdrawal:
• decreasing doses of the drug of
dependence
• substituting of phenobarbital
for the drug of dependence
 • substituting of a long acting
benzodiazepine for the drug of
dependence
Phenobarbital method
• the one most generally
applicable; widely used in drug
treatment programs because it
is the best choice used for
patients who have lost control
of their benzopdiazipine use or
who are polydrug users
• involves calculating a
phenobarbital replacement dose
for the total daily dose of the
sedative-hypnotic being used.
CENTRAL NERVOUS SYSTEM
STIMULANTS
Cocaine
• a naturally occuring alkaloid
derived from the Erythroxylon
coca plant
• second to marijuana as the most
frequently used drug of abuse
• a CNS stimulant and has
vasoconstrictive and local
anesthetic properties
• stimulant effect are caused by
blockade of reuptake of
dopamine, norepinephrine, and
serotonin
• associated with compulsive use
• snorting (2 min), smoking (6-8
sec) with 30 min half-life
• A/E: hypertension, arrythmias,
myocardial ischemia and infarction,
dilate and hypertrophic
cardiomyopathy, myocarditis, aortic
dissection and acceleration of
artherosclerosis
• Withdrawal syndrome: “crash”,
depression, fatigue, craving,
hypersomnolence and anxiety; can be
resolve within 1-2 weeks
• Txn of addiction: dopamine agonist,
antidepressants, carbamazepine,
methylphenidate (maintenance
treatment), cocaine vaccine (UI)
AMPHETAMINES
• Caffeine
• consumed worldwide in a
usually socially acceptable
manner in the form of coffee
and cola soft drinks
• Methamphetamine
• produces CNS stimulation by
enhancing the effects of
noepinephrine, serotonin ad
dopamine
• accomplished by both blocking
reuptake and stimulating
release of neurotransmitters
• half-life is 6-15 hours
• tolerance develops very rapidly
after continued use
• A/E: chronic users characteristically
develop complex paranoid delusional
systems with hallucinations during
extended periods of intoxication that
may involve several sleepless days
and nights of continuous
methamphetamine administration.
 • Txn of withdrawal: no effective
pharmacologic treatments have been
proved effected for meth dependence;
most effective is cognitive-behavioral
therapy
DISSOCIATIVE DRUGS:
PHENCYCLIDINE, KETAMINE AND
DEXTROMETHORPHAN
Ketamine
• commonly used as “club drug”
Dextromethorphan
• antitussive agent; a d-isomer of
the codeine analog of
levorphanol
• when ingested in large doses, it
produces similar effect to
ketamine or PCP
• 300-1800 mg, 3-6 hours “high”
PCP
• typical dissociative drug and
review of its effects largely
applies to ketamine and
dextromethorphan
• amnesia can occur following
intoxication
HALLUCINOGENS
• LSD
• a drug that could facilitate
psychotherapy
• one of the most potent
hallucinogens known (25-250
mcg)
• mild to moderate
sympathomimetic effects,
profound visual hallucnosis,
and the sensation of disordered
integration of sensory input
• A/E: mental state of acute
anxiety and fear aka “bad trip”
• therapy: “reality therapy”,
“talking down”
• long term effect: Hallucinogen
persisting perceptual disorder
(HPPD)
MDMA
• produces a very manageable
and comfortable entactogenic
effect
• the experience can be recalled
in detail, and the insights
gained during the session can
be incorporated into normal life
• onset of action: 30-60 min,
booster shot after 2 hours
• duration of action: 4-6 hours;
half life of 8 hours
• warning: hyperthermia which
led to rhabdomyolysis and
acute renal and hepatic failure,
disseminated intravascular
coagulation (DIC) and death
• txn: benzodiazepines, cooling
measures and IV fluids
MARIJUANA
• most widely used illicit substance
• THC is the main psychoactive
ingredient
• therapeutic potential:
 • relief of N/V, appetite 87 DRUG-INDUCED BLOOD
stimulation, treatment of pain, DISORDERS
epilepsy, glaucoma, migraine,
SECTION 19 NEOPLASTIC
anxiety, depression and
DISORDERS
movement disorders and
88 NEOPLASTIC DISORDERS AND
providing neuroprotection after
THEIR TREATMENT GENERAL
brain injury or cerebral
PRINCIPLES
iscehmia
89 ADVERSE EFFECTS OF
pharmacological effects:
CHEMOTHERAPY AND TARGETED
• sedation, mental relaxation, AGENTS
euphoria and mild
90 HEMATOLOGIC MALIGNANCIES
halluconogenic effects
91 SOLID TUMORS
A/E:
92 HEMATOPOIETIC STEM CELL
• anxiety, paranoia, TRANSPLANTATION
depersonalization,
SECTION 20 PEDIATRICS
disorientation and confusion
93 PEDIATRIC CONSIDERATIONS
Treatment:
94 NEONATAL THERAPY
• “talk down”, oral
benzodiazepine therapy 95 PEDIATRIC IMMUNIZATIONS
INHALANTS 96 PEDIATRIC INFECTIOUS
DISEASES
anesthetics
97 PEDIATRIC NUTRITION
3 main categories:
98 CYSTIC FIBROSIS
• volatile solvents
SECTION 21 GERIATRIC THERAPY
(hydrocarbons)
99 GERIATRIC DRUG USE
• volatile nitrites (amyl, butyl,
isobutyl, cyclohexyl) 100 GERIATRIC DEMENTIAS
• nitrous oxide (laughing gas) 101 GERIATRIC UROLOGIC
DISORDERS
effects: CNS depressant effect
102 OSTEOPOROSIS

84 ALCOHOL USE DISORDERS

85 TOBACCO USE AND
DEPENDENCE
SECTION 18 HAMATOPOIETIC
DISORDERS