HPA medications

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Aspirin

Trade names:

Aspro - Disprin - Astrix - Solprin

Chemical name:

Acetylsalicylic Acid

Therapeutic class:

NSAID/Antipyretic

Pharmacological class:

Salicylates

Indications:

Inflammatory disorders including osteoarthritis & rheumatoid arthritis

Mild - moderate pain

Fever

Prophylaxis of transient ischaemic attacks & MI

Actions:

Produces analgesia and reduces inflammation and fever by inhibiting the production of prostaglandins

Decreases platelet aggregation

Therapeutic effects:

Analgesia

Reduction of inflammation

Reduction of fever

Reduced incidence of transient ischaemic attacks & MI

Pharmacokinetics:

ABSORPTION: Well absorbed from the upper small intestine. Absorption from enteric-coated SR preps may be unreliable. Rectal absorption is slow and variable.

DISTRIBUTION: Rapidly and widely distributed; crosses the placenta & enters breast milk

METABOLISM + EXCRETION: Extensively metabolised by the liver, inactive metabolites excreted by the kidneys.

Half-life: 2 -3 hrs for low doses, 15 - 30 for high doses because of liver metabolism saturation

Contraindications/precautions:

Hypersensitivity to aspirin or other salicylates

Bleeding disorders or thrombocytopenia (low platelet count)

History of GI bleeding or ulcer disease

Asthma

Adverse reactions/ side effects:

EENT: tinnitus GI: bleeding, dyspepsia, epigastric distress, N + V, abdo pain HEP: toxicity HAEM: anemia, hemolysis, SKIN: rash, urticaria

Interactions:

May ^ the risk of bleeding with warfarin, heparins, heparin-like agents, thrombolytic agents

Assessment:

Pain assessment

Fever

Lab tests: monitor hepatic function if symptoms of hepatotoxicity occur or during long term use

Patient/family education:

Advise patient to report: tinnitus, bleeding of gums, easy bruising, black tarry stools, or fever > 3 days

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Insulin (short-acting)

Trade names:

Actrapid

Chemical name:

Insulin

Therapeutic class:

BGL regulator

Pharmacological class:

Endocrine

Indications:

Type 1 diabetes

Type 2 diabetes inadequately controlled with diet, exercise and oral antidiabetic drugs, and where oral antidiabetic drugs cannot be used

Actions:

Increase or restore ability to metabolise glucose by enhancing cellular glucose uptake

inhibit endogenous glucose output and lipolysis.

Therapeutic effects:

BGL reduction

Pharmacokinetics:

ABSORPTION: Well absorbed from subcutaneous abdominal injection, slower to absorb in other injection sites

DISTRIBUTION: Does not cross the placenta or enter breast milk - destroyed in the GIT

METABOLISM + EXCRETION: Extensively metabolised by the liver, inactive metabolites excreted by the kidneys.

Half-life: Varies with each preparation - metabolised at a cellular level

Contraindications/precautions:

Although insulin does not end up in breastmilk, it can cause a decrease in milk production

Adverse reactions/ side effects:

ENDO: hypoglycaemia, ketoacidosis,

Interactions:

Caution should be used when taking other drugs that decrease glucose levels in the blood such as MAOIs, betablockers, salicylates or alcohol. Dose should be adjusted accordingly. Betablockers can also interfere with signs of hypoglycaemia

Assessment:

BGL level pre and post

Baseline vital signs to assist with detecting hypo/hyperglycaemia

Monitor person's response to administration

Patient/family education:

Diabetes education: signs of hypoglycaemia, diet, exercise. Consider referral to diabetes education.

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Ampicillin

Trade names:

Ampicyn - Ibimycin - Austrapen

Chemical name:

Aminobenzylpenicillin

Therapeutic class:

Antiinfective

Pharmacological class:

Antibiotic - Penicillin

Indications:

Chronic bronchitis

CAP (community acquired pneumonia)

Gonnococal infection

Broad spectrum

Actions:

Bactericidal; interfere with bacterial cell wall peptidoglycan synthesis by binding to penicillin-binding proteins, eventually leading to cell lysis and death.

Therapeutic effects:

Reduction in bacterial infection

Pharmacokinetics:

ABSORPTION: Not well absorbed in GIT - best given via IV for optimal absorption

DISTRIBUTION: Does cross placenta and into breastmilk - however is said to be safe

METABOLISM + EXCRETION: partially metabolised by the liver, the remainder by the kidneys in urine.

Half-life: 1 - 11 hours

Contraindications/precautions:

Penicillin allergy!

Those with heart failure or on sodium restriction - high levels of sodium

Immunocompromised individuals = high incidence of rash

Renal impairment

Adverse reactions/ side effects:

Skin: rash GIT: diarrhoea, N + V, CNS: neurotoxicity at high doses/ renal impairment

Interactions:

Caution should be used when taking tetracyclines or aminoglycosides. Tetracyclines will decrease effectiveness of penicillin and penicillins will decrease the effectiveness of aminoglycosides.

Assessment:

Obtain specimen for culture

Baseline vital signs

Monitor person's response to administration

Patient/family education:

Tell patients to report adverse effects and the drink lots of fluids, and keep up nutrition.

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Cephazolin

Trade names:

Cefazolin - Kefzol

Chemical name:

Cephazolin Sodium

Therapeutic class:

Antiinfective

Pharmacological class:

Antibiotic - Cephalosporin

Indications:

Staphylococcal and streptococcal infections in people with mild-to-moderate penicillin allergy

Surgical prophylaxis

UTI

Actions:

Interfere with bacterial cell wall peptidoglycan synthesis by binding to penicillin-binding proteins, eventually leading to cell lysis and death; bactericidal.

Therapeutic effects:

Reduction in bacterial infection

Pharmacokinetics:

ABSORPTION: Not well absorbed in GIT - best given via IV for optimal absorption

DISTRIBUTION: Does cross placenta and into breastmilk - however is said to be safe

METABOLISM + EXCRETION: Excreted unchanged in urine

Half-life: 1.8 hours

Contraindications/precautions:

Some people who are allergic to penicillins are also allergic to cephalosporins

Those with heart failure or on sodium restriction - high levels of sodium

Immunocompromised individuals = high incidence of rash

Renal impairment

Adverse reactions/ side effects:

Skin: rash GIT: diarrhoea, N + V, CNS: neurotoxicity at high doses/ renal impairment

Interactions:

N/A

Assessment:

Obtain specimen for culture

Baseline vital signs

Monitor person's response to administration

Patient/family education:

Tell patients to report adverse effects and the drink lots of fluids, and keep up nutrition.

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