â–ŞTuberculosis
â–ŞImmunocompromised
â–ŞPregnancy
â–ŞActive infection
â–ŞSarcoidosis
â–ŞSepsis
â–ŞPeptic ulcer disease
â–ŞDiabetes mellitus
â–ŞRenal or hepatic dysfunction
â–ŞMalignant hypertension
Reference:PJ Mehta’s Practical Medicine
ADENOSINE – ADENOCARD, ADENOSCAN
HEPARIN
EPINEPHRINE- EPIPEN, ADRENALIN
Ensure correct brand is used as there are different formulations with different bioavailabilities. Complex interactions. Always check with existing drugs.
About:
-Methylxanthine Bronchodilator.
Action:
â–ŞCompetitive nonselective phosphodiesterase inhibitor
â–ŞRaises intracellular cAMP, activates PKA.
â–ŞInhibits TNF alpha and leukotriene synthesis
â–ŞAdenosine antagonist.
Indications:
â–ŞAcute Bronchospasm - Asthma and COPD.
â–ŞPulmonary oedema
Interactions :- check BNF as this list is not complete
â–ŞMetabolised by liver p450 system.
â–ŞSmokers, Chronic alcohol, Liver inducers reduce drugs levels. Need increased dose for same effects.
â–ŞLiver failure, heart failure, elderly, fluvoxamine, cimetidine, macrolides (erythromycin/clarithromycin)/ketoconoazole, fluconazole increase drug levels.
â–ŞIncreased Seizures with Quinolones.
Cautions:
â–ŞCardiac disease as may increase arrhythmias.
â–ŞEpilepsy, Hyperthyroidism.
â–ŞFever, Porphyria, Diabetes Mellitus.
Contraindications:
â–ŞAllergy.
â–ŞAcute porphyria.
Side effects:
â–ŞArrhythmias, Palpitations.
â–ŞSeizures, Delirium/Confusion, Insomnia, Restlessness.
â–ŞNausea, vomiting
Dose:
â–ŞAminophylline Oral : 225-450 mg bd for non smokers
â–ŞAminophylline Oral : 350-700 mg bd for smokers
â–ŞAminophylline IV : load 5 mg/kg (250-500 mg) and then 0.5 mg/kg/hour IVI
â–ŞMaintain plasma levels at 10-20 mg/l (55-110 micromole/l)
Reference:Drive
PJ Mehta's Practical Medicine Principles and Practice of Pharmaceutical Medicine Second Edition Edited by Lionel D. Edwards .
AMIODARONE- PACERONE,CORDARONE,NEXTERONE
Reference:PJ Mehta’s Practical Medicine .
Overdose accidental or otherwise. ABCs, monitor O2 sats and give oxygen. Respiratory and airway support. Flumazenil may be given with caution.
About:
•Long acting Benzodiazepine.
•Active metabolites have a half life of 100 hours.
Mode of action:
•Binds to a receptor on the GABA(A) receptor-chloride ionophore complex.
•Does not bind to the active site were GABA itself binds.
•Enhances the effect of GABA the main inhibitory neurotransmitter in CNS.
•GABA(A) receptor are ligand gated ion channels.
•Increases the frequency of Cl- channel opening and potentiating GABA transmission.
Indications:
•Anticonvulsant - clonazepam can act as an anticonvulsants with minimal sedation.
•Anxiolytic, Muscle relaxant, Hypnotic for insomnia, Premedication.
•Movement disorders, Myoclonus.
•Amnesia - useful for unpleasant procedures.
•Alcohol withdrawal.
Contraindications:
•Operating machinery, Sleep apnoea syndrome.
•Use with other sedation/alcohol
Respiratory depression, Respiratory muscle weakness.
•Myasthenia gravis , muscle weakness.
Cautions:
â–ŞDriving/operating machinery due to sedation.
â–ŞReduce dose in elderly, renal or liver failure.
Side effects:
â–ŞRespiratory depression, sedation, drowsiness, amnesia.
â–ŞRebound insomnia on stopping, Amnesia, Tolerance, Withdrawal.
â–ŞDrowsiness, Ataxia, reduced psychomotor performance.
â–ŞDependence after 4-6 weeks with a withdrawal syndrome.
â–ŞLong acting metabolites e.g. with Diazepam can give hangover effects.
Interactions:
â–ŞEffects are reversed by Flumazenil but risk of rebound seizure.
â–ŞCaution with other sedative medications.
â–Şp450 enzyme inhibitors can increase diazepam levels - See BNF/Datasheet.
â–ŞCaution with IM olanzapine.
Dose:
》Anxiety/Sedation : Diazepam 2 mg tds up to 30 mg per day in divided doses.
》Seizures: Diazepam 5-10 mg slow iv (Diazemuls is less irritating). Up to 20 mg may be used with skill and facilities for managing of any respiratory depression.
》Seizures : A PR Diazepam formulation can be used with doses of 2.5 mg/5 mg/10 mg/20 mg as required. Useful when IV access not available or in children.
Reference:Tara V Shanbhag
About:
>Treats hypoglycaemia.
>Treats Severe bradycardia related to beta blockers.
Mode of action:
>29 Amino acid polypeptide.
>Secreted by pancreatic alpha cells.
>Stimulates hepatic gluconeogenesis.
>Only for those with hepatic glycogen.
Indications:
>Hypoglycaemia.
>Beta Blocker overdoseDoses.
>Adults 0.5-1 mg sc/iv/im.
Contraindications:
>Phaeochromocytoma.
>Cachexia and malnutrition - does not work as liver glycogen stores are depleted.
Side effects:
>Hyperglycaemia.
Reference:Tara V Shanbhag 3rd edition
About:
¤Used in cardiac arrest setting or with symptomatic bradycardia.
¤Derived from an alkaloid extracted from deadly nightshade.
¤Was used to make women more attractive by dilating their pupils.
¤Deadly nightshade - Atropa belladonna.
Mode of action:
¤Competitive Muscarinic Ach blocker.
¤Blocks the action of acetyl choline.
Indications:
¤Symptomatic bradycardia.
¤Cardiac arrest setting.
¤Poisoning from organophosphates and nerve agents which increase Ach.
Interactions:
¤N/A
Contraindications:
¤Cardiac transplant - oversensitive use with great caution.
Side effects:
¤Reduced secretions, Delirium, Pupils dilate, Increased heart rate.
¤Relax smooth bowel, Urinary retention, Bronchodilation.
¤High dose - tachyarrhythmias e.g. VF,VT, SVT.
Atropine Dose:
¤Cardiac arrest up to 3 mg IV.
¤Bradycardia 500 mcg iv bolus repeated up to 3 mg IV.
¤Consider pacing if bradycardia induced hypotension persists.
Reference:Shanbhag Pharmacology 3rd edition
Not always clear whether it is hyperplasia or hypertrophyCan only be confirmed by determined by biopsy which is not always doneGingival enlargement is preferred terminology.
Vincent’s angina, ScurvySodium Valproate, Nifedipine, CiclosporinAcute Myeloid leukaemia (M5) – may regress after treatmentPregnancy, Oral contraceptive pill.
May be bleeding enlarged gumsAnaemia – ? AMLKnown epilepsy.
Specialist review of medications as appropriateGood dental care.
Burket’s Oral Medicine by Michael Glick
Dentowesome 