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:
▪Competitive nonselective phosphodiesterase inhibitor
▪Raises intracellular cAMP, activates PKA.
▪Inhibits TNF alpha and leukotriene synthesis
▪Adenosine antagonist.
Indications:
▪Acute Bronchospasm - Asthma and COPD.
▪Pulmonary oedema
Interactions :- check BNF as this list is not complete
▪Metabolised by liver p450 system.
▪Smokers, Chronic alcohol, Liver inducers reduce drugs levels. Need increased dose for same effects.
▪Liver failure, heart failure, elderly, fluvoxamine, cimetidine, macrolides (erythromycin/clarithromycin)/ketoconoazole, fluconazole increase drug levels.
▪Increased Seizures with Quinolones.
Cautions:
▪Cardiac disease as may increase arrhythmias.
▪Epilepsy, Hyperthyroidism.
▪Fever, Porphyria, Diabetes Mellitus.
Contraindications:
▪Allergy.
▪Acute porphyria.
Side effects:
▪Arrhythmias, Palpitations.
▪Seizures, Delirium/Confusion, Insomnia, Restlessness.
▪Nausea, vomiting
Dose:
▪Aminophylline Oral : 225-450 mg bd for non smokers
▪Aminophylline Oral : 350-700 mg bd for smokers
▪Aminophylline IV : load 5 mg/kg (250-500 mg) and then 0.5 mg/kg/hour IVI
▪Maintain 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:
▪Driving/operating machinery due to sedation.
▪Reduce dose in elderly, renal or liver failure.
Side effects:
▪Respiratory depression, sedation, drowsiness, amnesia.
▪Rebound insomnia on stopping, Amnesia, Tolerance, Withdrawal.
▪Drowsiness, Ataxia, reduced psychomotor performance.
▪Dependence after 4-6 weeks with a withdrawal syndrome.
▪Long acting metabolites e.g. with Diazepam can give hangover effects.
Interactions:
▪Effects are reversed by Flumazenil but risk of rebound seizure.
▪Caution with other sedative medications.
▪p450 enzyme inhibitors can increase diazepam levels - See BNF/Datasheet.
▪Caution 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
Antibiotics can be divided into 2 classes based on their mechanism of action:-
➡️ Bactericidal antibiotics kill bacteria by inhibiting cell wall synthesis. Example:
➡️ Bacteriostatic antibiotics limit the growth of bacteria by interfering with bacterial protein production, DNA replication or other aspects of bacterial cellular metabolism.
They must work together with immune system to remove the micro-organisms from the body. Example:
Note that while it is rational to favor bactericidal agents over bacteriostatic agents, neither has ever been shown to be superior (probably because true recovery from infection cannot occur until the body is able to mount an appropriate immune response, thus “buying time” may be just as good as active killing)
➡️ The MBC is the minimum concentration of drug which can kill the micro-organisms.
➡️ The MIC is the minimum concentration of drug which can inhibit the growth of micro-organisms.
Council for Appropriate and Rational Antibiotic Therapy (CARAT) criteria for accurate use of antibiotic therapy
● Evidence-based results ●Therapeutic benefits
● Safety
● Cost-effectiveness
● Optimal drug dose and duration —Shorter-course, more aggressive therapy
(i) Evidence-based results:
In choosing an antibiotic, clinicians should consider the clinical evidence demonstrating that the drug is clinically and microbiologically appropriate, the efficacy of that drug in well-designed clinical trials, and the antibiotic resistance patterns of the local region. Clinicians should then use their professional judgment to choose the optimal antibiotic.
(ii) Therapeutic benefits:
If possible, the clinician should identify the causative pathogen and use surveillance data on regional antibiotic resistance patterns in selecting the optimal therapeutic agent.
(iii) Safety:
In treating patients with a particular drug, safety must be weighed against efficacy. Clinically applicable treatment strategies should be chosen to maximize efficacy while minimizing side effects.
(iv) Optimal drug for optimal duration:
Optimal drug selection requires finding the antimicrobial class and the specific member of that class that is best suited to treat a particular infection. Because empiric therapy is necessary in most cases, multiple factors have to be considered. Among these are whether the etiologic agent is likely to be gram-positive or gram-negative, whether a narrow or broad-spectrum agent should be chosen, the resistance patterns of the likely pathogen to this drug, both nationally and regionally, and the individual patient’s medical history, including recent antibiotic exposure.
Optimal duration means prescribing the selected drug for the shortest amount of time required for clinical and micro- biologic efficacy. There are many reasons for reducing an- timicrobial therapy to the shortest appropriate duration. They include the potential for reduced occurrence of adverse effects, increased patient adherence, decreased promotion of resistance, and decreased costs.
(v) Cost-effectiveness:
Choosing inappropriate therapy is associated with increased costs, including the cost of the antibiotic and increases in overall costs of medical care because of treatment failures and adverse events.
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References:
| Mild/Moderate Pain | • Paracetemol • Low dose Ibuprofen |
| Post op. or short lasting pain | • Ketorolac, diclofenac |
| Musculoskeletal pain | • Paracetemol • Ibuprofen, naproxen, ketoprofen |
| RA,AS,Acute gout, Acute Rh. fever | • Naproxen, piroxicam • Indomethacin, high dose aspirin |
| GI irritation | • Paracetemol • Cox-2 inhibitors |
| H/O HS reaction to NSAIDs | • Paracetemol/ • Cox-2 inhibitors |
| Paediatric pt. | • Paracetemol, Ibuprofen & naproxen |
| Pregnancy | • Paracetemol |
Dentowesome 2020|@drmehnaz 🖊
Dentowesome 