PHARMACOLOGY (FINALS)
THYROID
 Butterfly-shaped organ located in the
base of your neck
 Releases thyroxine (T3) and
triiodothyronine (T4), that regulates
protein synthesis and enzyme activity
to stimulate mitochondrial stimulation
HYPOTHYROIDISM
 a decreased thyroid hormone secretion
 Primary cause- thyroid gland disorder
 Secondary cause- lack of TSH secretion
Myexdema- severe hyperthyroidism in adults
Symptoms: lethargy, apathy, memory
impairment, emotional changes, slow speech,
deep coarse voice, edema on eyelids and face,
thick dry skin, slow pulse
HYPERPARATHYROIDISM
Congenital Hyperthyroidism (Cretinism) or Pre-
pubertal Hypothyroidism (juvenile
hypothyroidism) – occurs in children
DRUG OF CHOICE: levothyroxine sodium
CALCITRIOL
MOA: increases T3 and T4 levels
Indication: replacement therapy for
hypothyroidism
HYPERTHYROIDISM
 increase thyroid hormone secretion of
T3 and T4 levels from an overacting
thyroid gland
 Graves disease (thyrotoxicosis) most
common due to hyperfunction of the
thyroid gland
DRUG OF CHOICE: antithyroid drugs
MOA: reduce excessive thyroid hormone
secretion
PARATHYROID
 Small glands of the endocrine system
that are located behind the thyroid
 Secretes PTH (parathyroid hormone)
which regulates calcium levels in blood
HYPOPARATHYROIDISM
 Rare condition that occurs when
parathyroid glands do not produce
enough hormone
Treatment:
 Parathyroid hormone agents
What to do:
 Blood test weekly or monthly after
diagnosis
 Maintain treatment and dietary
changes throughout life
 When parathyroid makes too much PTH
Treatment: synthetic calcitonin
 Vit. D
 Used to treat hyperthyroidism and
metabolic bone disease in people who
have chronic kidney failure and are not
receiving dialysis
 Use to treat hypocalcemia
 Use to treat calcium deficiency in
people with hypothyroidism caused by
surgery, disease or other condition
DIETARY SUPPLEMENTS
 Provides extra nutrients when the diet
is lacking or certain health condition
trigger a deficiency (cancer, diabetes,
chronic diarrhea)
Common Dietary Supplements:
Calcium- to maintain strong bones and carry
out important functions. Helps blood vessels
move blood throughout the body and release
hormones and enzymes that affects most of the
function in the body
Fish Oil- important in preventing and managing
heart disease, can lower blood pressure, reduce
triglycerides, slow plaque formation in arteries,
reduce heart attack and stroke.
Iron- helps transportation of oxygen in the
blood cells, iron deficiency can cause fatigue,
poor work performance and decrease immunity
MX3 (Mangosteen) – tropical fruit, fruit juice
and bark used as medicine. Used for diarrhea,
UTI, gonorrhea, thrush, tuberculosis, menstrual
disorders, cancer, osteoarthritis
Liveraid- used to improved liver function, gall
bladder disorders, high blood sugar, jaundice,
hepatic encephalopathy, alcohol abuse,
menstrual disorders and other condition
-Liveraid capsule works by lowering the alanine
aminotransferase and aspartate
aminotransferase levels, adjusting the cell
transporters thus inhibiting the apoptosis in
hepatocytes; treating high ammonia level in the
body
FDA (FOOD AND DRUG ADMINISTRATION)
CHEMOTHERAPY AGENTS
 Also referred to as antineoplastic
agents, are used to directly or indirectly
inhibit the proliferation of rapid
growing cells, typically in the context of
malignancy.
 They are classified according to their
MOA and include alkylating agents,
antimetabolites, topoisomerase
inhibitors, and mitotic inhibitors.
How it works?
 Kill both cancerous cells
 Fight only cancer cells
 Keep tumors from growing blood
vessels, which help them thrive
 Attack the cancer cells’ genes so the
cells die and can’t grow into new
tumors.
ANTIMETABOLITES
(Methotrexate Aminopterin) – interference with
synthesis of DNA and RNA during the S-phase
(Anthracycline Antibiotics)- Doxorubicin acts as
DNA intercalators
ALKALOIDS
(Vincristine, Vinblastine) – affect growth by
interfering with microtubular function during
metaphase, thereby arresting formation of
mitotic spindle.
ALKYLATING
(Melphalan, Chlorambucil, Cyclophosphamide,
Busulfan)- theoretically, bind to DNA
throughout the cell cycle.
ALTERNATIVE AND COMPLIMENTARY
THERAPIES

Alternative Medicine – treatments that are

used instead of standard medical treatments.
One example is using a special diet to treat
cancer instead of anticancer drugs that are
prescribed by an oncologist.

Complementary Medicine – treatments that

are used along with standard medical
treatments but are not considered to be
standard treatments. One example is using
acupuncture to help lessen some side effects of
cancer treatment.

Classification of CAM

Integrative Medicine- a practice that combines

conventional medicine with complementary
and alternative therapies.

Manipulative and Body-Based Practice- based

on manipulation or movement of one or more
body structures.

Natural Products- are based o substances found

in nature.

Mind-Body Medicine-use variety of techniques

to enhance the mind’s ability to affect bodily
function and symptoms.
DRUGS FOR EYE DISORDERS EPIPHORA – “watery eyes”

RED EYES - This happens when the surface is Due to Allergies:

covered in blood vessels that expand when
 Antihistamine
they’re irritated or infected.
 Decongestant
Drugs for Red Eye:  Eyedrops
Naphazoline - Decongestant that can treat
CONJUNCTIVITIS -Conjunctivitis is inflammation
redness caused by allergic reactions and minor
or infection of the membrane lining the eyelids
irritation.
(conjunctiva).
Tetrahydrozoline - Decongestant that, like
Drugs for Conjunctivitis:
naphazoline, clears redness caused by allergy,
Ophthalmic Steroids with Anti-infectives
exhaustion, and irritation.

REMEMBER: Avoid OTC eye drops for people
with glaucoma as this can increase pressure.
UVEITIS – inflammation of the uvea
Drugs for Uveitis:
Corticosteroids - For noninfectious uveitis,
treatment will usually include prescription
eye drops or ointments containing
corticosteroids to reduce inflammation.
For more severe cases, additional
immunosuppressive medications will be used.
 Examples that are used in the
treatment of uveitis
include methotrexate, azathioprine,
and mycophenolate mofetil.
DRY EYES- This happens when your eyes can't
make enough good-quality tears.
Drugs for Dry Eyes:
Cyclosporine- It is also used to treat patients
with rheumatoid arthritis and psoriasis. This
drug suppresses the immune system so that the
body stops attacking itself.
 Contain steroids and anti-infectives.
 Steroids are effective anti-inflammatory
agents and are used to treat pain and
inflammation.
 The anti-infectives commonly present in
eye drops are antibiotics that either kill
or inhibit the growth of bacteria.
Lotemax (loteprednol ophthalmic)
sulfacetamide sodium
GLAUCOMA- Increased intraocular pressure in
the eye
Drugs for Glaucoma:
Prostaglandins - Relaxing muscles in the eye's
interior structure to allow better outflow of
fluids.
 Xalatan (Pfizer)
 Lumigan (Allergan)
 Travatan Z (Alcon)
 Rescula (Novartis)
Beta-Blockers - Decreasing fluid (aqueous)
production in the eye

Lifitegrast - Another prescription medication  Timoptic XE (Merck)

specifically approved for chronic dry eye  Istalol (ISTA)
treatment.  Betoptic S (Alcon)
Alpha-adrenergic agonists - Decreasing fluid CHORIODITIS- Chorioditis is an inflammatory
(aqueous) production in the eye condition of the choroid membrane of the eye.

 Iopidine (Alcon) Glucocorticoids - Glucocorticoids are a group of

 Alphagan (Allergan) drugs with various anti-
 Alphagan-P (Allergan) inflammatory and immunosuppressant

Carbonic anhydrase inhibitors- Decreasing rate • They exert their main anti-
of aqueous humor production. inflammatory and actions by binding to
glucocorticoid receptors
 Neptazane (Wyeth-Ayerst)
 Azopt (Alcon) • Common glucorticoid: Clinacort
(triamcinolone)

BLEPHARITIS - An inflammation of the lash

follicles at the eyelid margins due to excess
growth lash follicles of bacteria normally
present on the skin.

Ophthalmic Steroids with Anti-infectives

• Contain steroids and anti-infectives.

• Steroids are effective anti-inflammatory

agents and are used to treat pain and
inflammation.

• The anti-infectives commonly present in

eye drops are antibiotics that either kill
or inhibit the growth of bacteria.

Common ophthalmic steroids:

 Blephamide (prednisolone /
sulfacetamide sodium ophthalmic)
 Maxitrol (dexamethasone / neomycin /
polymyxin b ophthalmic)
 Neo-Poly-Dex (dexamethasone /
neomycin / polymyxin b ophthalmic)
DRUGS FOR EAR DISORDER
EAR DISORDER- caused by problems in the
neck, ear, sinus or head, inflammation, babies
and children are more vulnerable to ear
infection, especially middle ear infection.
Auditory Processing Disorder - also known as
central auditory processing disorder or CAPD. A
hearing problem that affects about 5% of school-
aged children. Kids with this condition can't
process what they hear in the same way other
kids do because their ears and brain don't fully
coordinate
DRUGS FOR CAPD:
Drug class: CNS stimulants
Generic name: dexmethylphenidate systemic
Brand name: Ritalin, Concerta
• used to treat attention deficit
hyperactivity disorder in those over the
age of 5 years.
• taken by mouth
Ear Wax Impaction -occurs when the wax gets
pushed deep within the ear canal. One of the
most common ear problems.
DRUGS FOR EAR WAX IMPACTION:
Drug class: cerumenolytics
Generic name: carbamide peroxide otic
Brand name: Debrox, Murine Earwax Removal,
Auraphene-B, Auro, Mollifene, Murine Ear
drops
• used to soften and loosen earwax
Eustachian Tube Dysfunction
DRUGS FOR ETD:
Drug class: antihistamines, miscellaneous
anxiolyics,sedatives and hypnotics
Generic name: cetirizine systemic,
diphenhydramin systemic
Brand name: Zyrtec, Benadryl
• ETD caused by allergies may find relief
using antihistamines
Drug class: Nonsteroidal anti-inflammatory
drugs
Generic name: ibuprofen systemic
Brand name: Ibuprofen
• used to reduce pain and decrease
inflammation
Meniere's Disease- disorder of the inner ear that
causes severe dizziness (vertigo), ringing in the
ears (tinnitus), hearing loss and a feeling of
fullness or congestion in the ear. Usually affects
only one ear
DRUGS FOR MENIERE’S DISEASE:
Drug class: benzodiazepines, benzodiazepine
anticonvulsants
Generic name: diazepam systemic
Brand name: Valium
• can help with the spinning sensation, as
well as nausea and vomiting
Otitis Externa - condition that causes
inflammation (redness and swelling) of the
external ear canala which is the tube between
the outer ear and eardrum. Referred to as
swimmer's ear.
DRUGS FOR OTITIS EXTERNA:
Drug class: otic steroids and anti-infectives
Generic name: ciprofloxacin/dexamethasone
otic
Brand name: Ciprodex
• Used to treat steroid – responsive
inflammatory conditions for which a
corticosteroid is indicated and which
bacterial infection or a risk of bacterial
infection exists.
Generic name: acetic acid /hydrocortisone otic
Brand name: Acetasol HC, Vosol HC
Drug class: otic steroids and anti-infectives
• Is an effective treatment in most cases
and when used after exposure to
moisture and an excellent prophylactic
in ear disorder.
Drug class: third generation cephalosporins
Generic name: ceftazidime systemic, cefdinir
systemic
Brand name: Tazicef, Cefdinir
Drug class: otic anti-infectives
Generic name: acetic acid / aluminum acetate
otic
Brand name: Star-Otic, Borofair
• Available as ear drops and contain anti-
infective agents that have antibacterial
or antifungal activity.
• Kill or inhibit bacterial or fungal growth
Otitis Media- a group of inflammatory
diseases of the middle ear
DRUGS FOR OTITIS MEDIA:
Drug class: aminopenicillins
Generic name: amoxicillin systemic
Brand name: Amoxil, Moxilin,Apo-Amoxi
• Excellent for treating infections due to
beta-lactamase-producing H influenzae
and penicillinase-producing anaerobes.
• Commonly used to treat infections
Drug class: beta-lactamase inhibitors
Generic name: amoxicillin/calvulanate systemic
Brand name: Augmentin , Augmentin ES-600,
Augmentin XR, Amoclan
• Acts as a competitive “suicide” inhibitor
of many plasmid-mediated and
chromosomes-mediated bacterial beta
lactamases.
• Excellent choice for second-line therapy
in AOM or initial therapy in OME.
Drug class: beta-lactamase inhibitors
Generic name: amoxicillin/calvulanate systemic
Brand name: Augmentin, Augmentin ES-600,
Augmentin XR, Amoclan
• Acts as a competitive “suicide” inhibitor
of many plasmid-mediated and
chromosomes-mediated bacterial beta
lactamases.
• Excellent choice for second-line therapy
in AOM or initial therapy in OME.
Drug class: macrolides
Generic name: azithromycin systemic
Brand name: Azithromycin Dose Pack
• Often used to treat children with acute
otitis media.
• One of the excellent choice for
antibiotic
Drug class: first generation cephalosporins
Generic name: cephalexin systemic
Brand name: Keflex,Daxbia
DRUGS ACTING ON IMMUNE SYSTEM
Lymphatic system
• It's a network of lymph nodes and
vessels.
• Lymphatic vessels are thin tubes that
spread, like blood vessels, all over the
body.
• They carry a clear fluid called lymph.
Lymph contains tissue fluid, waste
products, and immune system cells.
• Lymph nodes are small, bean-shaped
clumps of immune system cells. They
are connected by lymphatic vessels.
• They contain white blood cells that trap
viruses, bacteria, and other invaders,
including cancer cells.
Autoimmune Disorders
Type 1 diabetes. The immune
system attacks the cells in the pancreas that
make insulin. Insulin removes sugar from the
blood to use as energy.
Rheumatoid arthritis. This type of
arthritis causes swelling and deformities of the
joints. An autoantibody called rheumatoid
factor is in the blood of some people with
rheumatoid arthritis.
Lupus. This disease attacks body tissues,
including the lungs, kidneys, and skin. Many
types of autoantibodies are found in the blood
of people with lupus.
Autoimmunity -arise when body mounts an
immune response against itself failure to
distinguish self-tissues and cells from foreign
antigens.
Drugs for Autoimmune Disorders:
• Xeljanz (tofacitinib) Route: Oral (Severe
Rheumatoid Arthritis)
• Olumiant (baricitinib) Route: Oral
(Psoriatic Arthritis, Lupus, Rheumatoid
Arthritis)
• Cosentyx (secukinumab) Route:
Parenteral (Rheumatoid Arthritis)
Abnormal Immune response
 Hypersensitivity Reactions
 Asthma. The response in your lungs can
cause coughing, wheezing, and trouble
breathing. Asthma can be triggered by
common allergens like dust or pollen or
by an irritant like tobacco smoke.
 Eczema. An allergen causes an itchy
rash known as atopic dermatitis.
 Hay fever (allergic rhinitis). Sneezing, a
runny nose, sniffling, and swelling of
your nasal passages from indoor
allergens such as dust and pets or
outdoor allergens such as pollens or
molds.
 Food allergy. Severe allergic reactions
that are caused by foods.
Abnormal Immune Response -born with certain
genes, immune system may react to substances
in the environment that are normally harmless
substances (Allergens: dust, mold, pollen, and
foods)
Drugs for Hay Fever and Food Allergy:
• Antihistamines (Hay Fever, Food
Allergy)
• Nasal Steroids (Hay Fever)
• Decongestant (Hay Fever)
Drugs for Anaphylaxis: Temporary acquired immune
deficiencies. immune system can be weakened
• Epinephrine
by certain medicines for chemotherapy,
• H1 antihistamine medication after organ transplant to avoid
rejection, people on chemotherapy or other
Drugs for Asthma: (SIDE EFFECTS: Anxiety, medicines used to treat cancer. Even infections
Tremor, Restlessness, Headache, Fast and like flu virus and mononucleosis. Measles can be
irregular heartbeats.) a factor for weakened immune system. Smoking,
• Albuterol (ProAir HFA, Proventil HFA, drinking alcohol and poor nutrition
Ventolin HFA) AIDS. HIV, which causes AIDS, is an acquired
• Levalbuterol (Xopenex HFA) viral infection that destroys important white
blood cells and weakens the immune
• Metaproterenol system. People with HIV/AIDS can become
• Terbutaline seriously ill with infections that most people can
fight off. These infections are called
Drugs for Eczema: “opportunistic infections” because they take
advantage of weak immune systems.
Calceneurin inhibitor-reduces inflammation by
modifying immune system (SIDE EFFECTS: Immunodeficiency - An immune deficiency
Burning, Skin Irritation, Itching) disease occurs when the immune system is not
working properly. If you are born with a
• tacrolimus (Protopic)
deficiency or if there is a genetic cause, it is called
• pimecrolimus (Elidel) primary immunodeficiency disease.

Oral Medications (risk for infection, nausea, Drugs for SCID (Severe combined
high blood pressure, kidney or liver damage) immunodeficiency):
 bovine-derived ADA replacement
• azathioprine (Imuran)
enzyme pegademase (Adagen) Route:
• Cyclosporine Intramuscular (SIDE EFFECT: bleeding,
bruising, pain at the site)
• Methotrexate
 Trimethoprim-
• oral steroids (prednisone) sulfamethoxazole [prescribed routinely
after the second month of life in children
with (SCID) until after bone marrow
Immunodeficiency Disease transplant (BMT) engraftment.]

Severe combined immunodeficiency Drugs for AIDS/HIV:

(SCID). This is an example of an immune Nucleoside reverse transcriptase inhibitors
deficiency that is present at birth. Children are in (NTRIs) – known as “nukes” prevents HIV from
constant danger of infections from bacteria, replicating in the body
viruses, and fungi. This disorder is sometimes • abacavir (Ziagen)
called “bubble boy disease.”
• lamivudine (Epivir)

• zidovudine (Retrovir)
Non-nucleoside reverse transcriptase ADRENAL CORTEX
inhibitors (NNTRIs) – works the same as NTRIs
ZONA FASCICULATA: CORTISOL
prevents replication of virus
- control the body’s use of fats, proteins and
• efavirenz (Sustiva) carbohydrates; suppresses inflammation;
regulates blood pressure; increases blood sugar;
• etravirine (Intelence)
and can also decrease bone formation; controls
• neviparine (Viramune) the sleep/wake cycle.

Protease Inhibitor -binds to protease that HIV ZONA GLOMERULOSA: ALDOSTERONE

needs to replicate - central role in regulating blood pressure and
• atazanvir/cobicistat (Evotaz) certain electrolytes (sodium and potassium)

• darunavir/cobicistat (Prezcobix) ZONA RETICULARIS: DHEA AND ANDROGENIC

• lopinavir/ritonavir (Kaletra) STEROIDS
- weak male hormones; precursor hormones that
• ritonavir (used to boost other are converted in the ovaries into estrogens and
medications) androgens
HIV drugs side effects: Diarrhea, Dizziness,
Headaches, Fatigue, Muscle aches, Nausea and
ADRENAL MEDULLA
Vomiting
- main hormones secreted by the adrenal
medulla include epinephrine (adrenaline) and
norepinephrine (noradrenaline), which have
[ADRENAL GLAND, GLUCOCORTICOIDS AND
similar functions
MINERALOCORTICOIDS]
- capable of increasing the heart rate and force
ADRENAL GLAND- A.K.A. as suprarenal gland,
of heart contractions, increasing blood flow to
produce hormones that help regulate your
the muscles and brain, relaxing airway smooth
metabolism, immune system, blood pressure,
muscles, and assisting in glucose metabolism.
response to stress and other essential functions.
They also control vasoconstriction, helping
Two main parts: Cortex and Medulla.
maintain blood pressure and increasing it in
Glucocorticoids - class of corticosteroids that is response to stress
produced in the adrenal cortex to regulate or
support physiological processes in the
cardiovascular, metabolic, immunologic, and ADRENAL GLAND DISORDERS
other systems. It is a powerful anti-inflammatory
agent ADDISON'S DISEASE- characterized by low levels
of adrenal hormones
Mineralocorticoids - class of corticosteroids
produced in the adrenal cortex used to describe OVERACTIVE ADRENAL GLANDS- adrenal glands
those actions of adrenal corticosteroids may develop nodules that produce too much of
producing sodium and fluid retention and certain hormone
potassium excretion. act on cells in the distal
renal tubule and cortical collecting duct
CONGENITAL ADRENAL HYPERPLASIA- missing Fludrocortisone - Replacement treatment in
an essential enzyme necessary to produce people with Addison's disease or following
cortisol, aldosterone or both surgical removal of the adrenal glands

CONTRAINDICATIONS:
CUSHING SYNDROME- excessive production of
high blood pressure; history of heart attack;
cortisol from the adrenal glands
diabetes; liver disorder; pregnant or
breastfeeding; osteoporosis; epilepsy; stomach
HYPERALDOSTERONISM- overproduction of
ulcer; inflammatory bowel disorder; history of
aldosterone from one or both adrenal glands
TB; recently had chickenpox, measles or shingles;
myasthenia gravis
ADRENAL CANCER - Malignant adrenal tumors,
such as adrenocortical carcinoma, are rare and
CONSIDERATIONS:
often have spread to other organs and tissues by
• Position patient to sit with their feet up
the time they are diagnosed
• Eat little and often.
• Do not allow patient to drive and use tools or
PHEOCHROMOCYTOMA - tumor that results in
machines.
excess production of adrenaline or
•Assess for blurred vision or other vision
noradrenaline by the adrenal medulla that often
problems.
happens in bursts

DRUGS FOR MANAGEMENT OF ADRENAL

DISORDERS
Hydrocortisone - Cortisol replacement
treatment in people with Addison's disease or
following surgical removal of the adrenal glands

CONTRAINDICATIONS:
high blood pressure; history of heart attack;
diabetes; liver disorder; pregnant or
breastfeeding; osteoporosis; epilepsy; stomach
ulcer; inflammatory bowel disorder; history of
TB; recent or about to have, any vaccinations

CONSIDERATIONS:
• Position patient to sit with their feet up
• Eat little and often.
• Do not allow patient to drive and use tools or
machines.