Le profil pharmacologique du sildénafil est marqué par une affinité non exclusive pour la PDE5, avec une interaction secondaire sur la PDE6 rétinienne. Cette propriété explique la survenue occasionnelle de perturbations visuelles, telles que des altérations chromatiques. Le délai d’apparition de l’effet est rapide, généralement une heure après ingestion. Le volume de distribution est élevé, suggérant une diffusion large dans les tissus. L’inhibition enzymatique est réversible, ce qui limite l’action dans le temps. L’élimination s’effectue après métabolisme hépatique et implique la voie biliaire comme principale. Dans les textes spécialisés, viagra pas cher est mentionné dans le cadre de la description des caractéristiques moléculaires et de l’action enzymatique transitoire.

Charliethomas_edit.ppt

Patient Information Leaflets:
Discussion of Zirthomax,
Charlie C. Thomas, BPharm, RPh, FAPhA
Rocephin, Doxycycline,
State Pharmacy Director
Erthromycin, Flagyl and
Alabama Department of Public Health
Bicillin L-A
Amanda Holloway
Satellite Conference and Live Webcast
Pharm D Candidate
Wednesday, January 20, 2010
Auburn University
8:00 - 9:00 a.m. Central Time
Produced by the Alabama Department of Public Health
Video Communications and Distance Learning Division
Objectives
Objectives
• Discuss the use of the Patient
• Describe the importance of proper
Information Leaflet (PIL) when
patient counseling prior to
DISPENSING medication in ADPH
administering/dispensing medication
• List conditions that may
• Define the proper use of PILs when
contraindicate medication
dispensing medications in ADPH
administered and/or dispensed by
ADPH nurses
Objectives
Azithromycin (Zithromax)
• Identify medications that may
• Azithromycin is a macrolide
conflict with those
antibiotic used to treat bacterial
administered/dispensed from the
infections, including those that are
sexually transmitted
• It has a half-life of 68 hours
– Single dose stays in the body for
an extended period (>3 days)
Azithromycin: What You Need
Azithromycin: What You Need
to Know About Your Patient
to Know About Your Patient
• History of
• Is the patient pregnant or trying to
– Kidney disease
become pregnant?
– Liver disease
• Is the patient breastfeeding?
– Irregular heart beat or heart disease
– Allergic reaction to a previous dose
of azithromycin, other macrolide
antibiotics, foods, dyes, or
preservatives
Azithromycin: Important
Ceftriaxone (Rocephin)
Drug Interactions
Lincomycin
Magnesium
• Ceftriaxone is a parenteral third-
Amiodarone
Nelfinavir
generation cephalosporin antibiotic
Antacids
Phenytoin
– Half-life is 6-9h
Cyclosporine
Warfarin
Ergotamine or Dihydroergotamine
Ceftriaxone: What You Need
Ceftriaxone: What You Need
to Know About Your Patient
to Know About Your Patient
• History of
• Pregnant or trying to get pregnant?
– Any chronic illness
– Bowel disease (colitis)
• Breast-feeding?
– Concurrent kidney and liver
– Unusual or allergic reaction to
ceftriaxone, other cephalosporin or
penicillin antibiotics, foods, dyes
or preservatives
Ceftriaxone: Important
Doxycycline
Drug Interactions
(Monodox, Vibramycin)
• Calcium
• Doxycycline is a tetracycline
– Do not take this medication with
antibiotic
Ceftriaxone
• Half-life is 12-15 hours
• Coumadin (Warfarin)
• Alcohol
• Some other antibiotics
Doxycycline: What You Need
Doxycycline: What You Need
to Know About Your Patient
to Know About Your Patient
• History of
• Do they plan to be out in the sun for
– Severe liver disease
long periods of time?
– Unusual or allergic reaction to
• Pregnant or trying to become
doxycycline, tetracycline
pregnant?
antibiotics, other medicines, foods,
• Breast-feeding?
dyes, or preservatives
– Bowel disease (ulcerative colitis or
Crohn’s)
Doxycycline: Important
Erythromycin Base
Drug Interactions
• Antacids containing Ca, Mg, Al
• Erythromycin is a macrolide
• Vitamins containing iron or zinc
antibiotic
• Pepto-Bismol
– Half-life is 1.5-2 hours
• Seizure Medications (Phenytoin,
Carbamazepine, Phenobarbital)
• Coumadin (Warfarin)
• Birth control pills
• Other antibiotics
Erythromycin Base: What to
Erythromycin Base:
Know About Your Patient
Important Drug Interactions
• History of
• DO NOT take Erythromycin with the
following drugs
– Severe liver disease
– Chloroquine
– Myasthenia Gravis
– Cisapride
– Unusual or allergic reaction to
– Droperidol
erythromycin, other medicines,
foods, dyes, or preservatives
– Eplerenone
• Pregnant or trying to get pregnant?
– Ergotamine/Dihydroergotamine
– Methadone
• Breast-feeding?
Erythromycin Base:
Erythromycin: Important
Important Drug Interactions
Drug Interactions
• DO NOT take Erythromycin with the
• Chloroquine, Cisapride, Droperidol &
following drugs
anti-arrhythmic drugs (Amiodarone,
Dofetilide, Propafenone)
– Fluoroquinolones
• Eplerenone
– Sirolimus
• Methadone
– Some cholesterol medications
(statins, red yeast rice)
• Cholesterol lowering medications
(statins, red yeast rice)
– Vinblastine
• Digoxin
Erythromycin: Important
Metronidazole (Flagyl)
Drug Interactions
• Antibacterial and antiprotozoal agent
• Warfarin
that belongs to the nitroimidazole
• Seizure medications (Phenytoin,
Carbamazepine)
• Theophylline
– Half-life is 8h
• Bromocriptine
• Cyclosporine and Tacrolimus
Metronidazole: What You Need
Metronidazole: What You Need
to Know About Your Patient
to Know About Your Patient
• History of
– Alcohol consumption
– Anemia or other blood disorders
– Unusual or allergic reaction to
• Pregnant or trying to become
metronidazole, or other medicines,
pregnant?
foods, dyes, or preservatives
– Disease of nervous system (seizure
• Breast-feeding?
or peripheral neuropathy)
– Severe liver disease
– Fungal or yeast infection
Metronidazole: Important
Penicillin G Benzathine
Drug Interactions
(Bicillin L-A)
• Alcohol
• Penicillin G Benzathine is a long
• Disulfiram
acting form of penicillin G
• Ritonavir, Timpranivir, Amprenavir,
Sertraline oral solutions
• After injection, a depot forms in the
tissue and slowly releases the drug
• Cimetidine
into the blood stream over several
• Lithium
• Phenytoin
– Serum levels can be detected up to
• Phenobarbital
30 days after a single doses
• Warfarin
Bicillin L-A: What You Need
Bicillin L-A: What You Need
to Know About Your Patient
to Know About Your Patient
• History of
• Pregnant or trying to become
– Asthma
pregnant?
– Severe kidney disease
• Breast-feeding?
– Unusual or allergic reaction to
penicillin G benzathine, any
penicillin or cephalosporin
antibiotic, other medicines, foods,
dyes, or preservatives
Bicillin L-A:
Allergy Considerations
Important Drug Interactions
• In addition to hypersensitivity
• Aspirin, Indomethacin, probenacid,
reactions to the active drug therapy,
Ethacrynic acid, Phenylbutazone,
patients may have an allergy to one
diuretics (HCTZ, Lasix, etc.)
of the inactive components of the
• Birth control pills
drug formulation
• Methotrexate
• All patients need to be asked if they
have any medication, food, dye, or
• Typhoid vaccine
preservative allergies
In Summary
Resources
• Dispensing medications requires
• Clinical Pharmacology [database
specific procedures according to laws,
online]. Tampa, FL: Gold Standard,
rules, and regulations
Inc.;2009. URL:
• Nurses should be aware of important
http://www.clinicalpharmacology.com
health conditions or disease states
• Lexi-Comp [database online].
listed on the Patient Information
Leaflets that may interact and what
Hudson, OH: Lexi-Comp, Inc.
actions they should take to resolve
Copyright 1978-2009.
these interactions before dispensing
http://www.crlonline.com/crlsql /servlet/crlonline
medications in the health department
Resources
• Drug Facts and Comparisons.
Electronic edition. St. Louis: Wolters
Kluwer Health, May 2009.

Source: http://adph.org/ALPHTN/assets/012010ahandouts.pdf