Pharm 2-2

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felizdiaz
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49782
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Pharm 2-2
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2010-11-24 09:58:16
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pharm 2-2
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  1. THIAZIDE DIURETICS
    • -THIAZIDES, -ONE
    • JNC7 INTIAL TX FOR ESSENTIAL HTN OR IN COMB WITH OTHER HTN MED
    • PO IV(MOBILIZE EDEMA)
    • TX HTN, DI, HYPERCALCEMIA
    • MED, CHLOROTHIAZIDES, CHLORTHALIDONE, HYDROCHLOROTHIAZIDE, HYDRODIURIL, INDAPMIDE, METHYCLOTHIAZIDE, METOLAZONE
    • MOA; STOP REABORBATION OF NA AND CHLORIDE IN LOOP ASCEDING PART OF HENLE AND PROX AND DISTAL RENAL TUBE
    • DOES NOT WORK AS WELL WITH POOR GFR
    • EFFECTS;
  2. THIAZIDE MED
    CHLOROTHIAZIDES, CHLORTHALIDONE, HYDROCHLOROTHIAZIDE, HYDRODIURIL, INDAPMIDE, METHYCLOTHIAZIDE, METOLAZONE
  3. THIAZIDE MEC OF ACTION AND EFFECTS
    MOA; STOP REABORBATION OF NA AND CHLORIDE IN LOOP ASCEDING PART OF HENLE AND PROX AND DISTAL RENAL TUBE

    • EFFECTS; INITALLY DECREASE EXTRACELL FLUID VOL THUS LO BP AND CO
    • THEN IT IS THOUGHT THAT WITH LO NA STORES IT DIM THE SNS
  4. THIAZIDES SE
    • SE- LO K, CL, GLUCOSE, AND MAG META ALKALOSIS
    • LO K= CARDIO ARRHY, SKELETAL MUSCLE WEAKNESS, DIG TOX, ILEUS,
    • LO INTRAVAS VOL, UP BUN AND HCT, UP URIC ACID (GOUT)
  5. LOOP DIURETICS WITH MEDS MOA
    • STOP REABSORPTION OF NA AND CL IN ASCENDING LOOP OF HENLE
    • RESPONDS WELL TO GOOD OR BAD GFR

    MEDS: BUMTANIDE, ETHACRYNIC ACID (NO SULFA BUT POTENT), FURSEMIDE, TORSEMIDE
  6. LOOP DIURETICS
    • 1. MOBLIZATION OF FLUID
    • LASIX 0.1-1 MG/KG TO LO EDEMA DT LIVE, CARDIO OR RENAL FAILURE
    • PERI VASODIL PRIOR TO DIURESIS(REASON WHY WORKS FOR ON PUL EDEMA)
    • 2. TX UP ICP
    • LO CSF, AND IMPROVING CELLULAR WATER TRANSPORT
    • WORK WELL WITH MANNITOL (BETTER TOGETHER THAN ALONE BUT UP DEHYDRATION AND ELECTROLYTE IMBALANCE)
    • 3. DIFFERENTIAL DIA OF ACUTE OLIGURA (SEE IF DRY)
    • SMALL DOSE(0.1 MG/KG) BUT NOW MORE COMMON FOR BOLUS CHALLANGE
    • 4. ACUTE RENAL FAILURE
    • CONTROVERSIAL, ATTEMPTS RO CONVERT OLIGURIC TO NONOLIGURIC RENAL FAILURE (NO REAL PROVINE RESULTS)
  7. LOOP SE
    • LO K, CL
    • UP SUGAR, BICARB, DIG TOX, NEPHROTOX, SENSITIVITY TO SULFONAMIDES (X EA)
    • IF PUSHED TO FAST DAMAGE TO CN8 (DEAFNESS)
    • LO CLEAREANCE TO LITHUM
  8. OSMOTIC DIURETICS
    • MANNITOL AND UREA
    • RESIST META
    • UP OSMOTIC PRESSURE AND PULL FLUID INTO THE INTRAVASCULAR SPACE
    • PT WITH CHF MAY NOT TOL INCREASE IN VOL
  9. MANNITOL
    • UP OSMOLARITY OF RENAL TUBELE AND PREVENTS WATER REABS
    • WITH UP OSMOLARITY DRAW WATER INTRAVAS DECREASING BRAIN BULK AND UP RENAL BLOOD FLOW
    • USE; PROPHLAXIS OF ARF- SURGERY, TRAUMA, AND BLOOD RX
    • ICP- 0.25-1 G-KG WORKINGS IS 10-15 MIN AND LAST 2 HOURS (LOWERS CSF) DON'T GIVE IT BBB IS NOT INTACT (LESS EFFECTIVE OVER TIME)
    • INTRACULAR PRESSURE-SHORT TERM REDUCTION
    • ACUTE OLIGURA-0.25 G/KG IV IF HAVE REALLY BAD GFR OR RENAL TUBULAR FX THEN WILL NOT WORK

    SE- PUL EDEMA, CHF, HYPOVOL, NEHTOTOXIN, EXCESSIVE LOSS OF H20 AND NA
  10. UREA
    • SMALL SIZE VS MANNITOL AND IS FILTER IN KIDNEY
    • CROSSES BBB AND CAUSES REBOUND INTRACRNAIL PRESSURE
    • SE VENOUS THROMBOSIS, AND TISSUE NECROSIS
  11. POTASSUIM SPARRING DIURETICS
    • MOA- ACT ON R TUBULAR TRANSPORT OF DISTAL CONVULTED TUBULE SPARRING K BUT OUT NA, CL AND BICARB (UP URINE pH)
    • MEDS AMILORIDE, AND TRIAMTERENE
    • USE; WITH THIAZIDE FOR HTN, MIX THE TWO TO HAVE NEUTRAL EFFECT ON K
    • SE HYPER K
  12. ALDOSTERONE ANTAGONIST
    • SPIRANOLACTONE (LOOKS LIKE ALDOSTERONE)
    • BLOCKS ITS EFFECTS THOUGH OF ALDOSTERONE
    • USE- ASCITIES DT CIRRHOSIS OF LIVEER, CHF, HTN WITH THIAZIDES
    • SE- HYPER K, ANTIANDROGEN (ESTROGEN MORE PROMENANTE)
  13. EPLERONONE
    • SELECTIVE ALDOSTERONE ANTAGONIST
    • BLOCK AND BIND TO ALDOSTERONE
    • LIKE SPIRONOLACTONE BUT IS NOT AS STRONG ANTIANDROGEN
    • USE; CHF , LOWERS SEXUAL DYSFUNCTION, HTN
    • SE- MI, ANGINA, HYPERK, ARRHYTHMIAS
  14. CARBONIC ANHYDRASE
    • ACETAZOLAMIDE (SULFONAMINDE THAT BINDS TO CARBONIC ANHYDRASE)
    • LOSS NA, AND BICARB (KEEP CL)
    • TX META ALKALOSIS, INTRAOCULAR PRESSURE, LO SEIZURE ACTIVITY, AND ALTITUDE SICKNESS. LO CSF
  15. PLASMA KINIINS
    • POLYPEPTIDES
    • MOST POTENT ENDOGENOUS VASODILATORS
    • INCREASE CAP PERMEABILITY=EDEMA, BURNING PAIN AT NERVE ENDINGS
    • LAST >15 SEC,M 90% META VIA LUNG FIRST PASS,
    • LEDS TO COUGH AND ANGIOEDEMA
  16. BRDAYKININS
    • INCREASE LEVEL DT S SHOCK, ALLERIGIC REACTIONS, CORCINOID SYNDROME
    • LOW AMOUNTS=HTN
    • TOO MUCH = REACTION
  17. APROTININ
    • BRADYKININ
    • (OUT OF FAVOR)
    • USED TO REDUCE BLOOD LOSS DURING RE-OPERATION(BYPASS OR GREAT VESSELS), ON COUMADIN OT TPA, JEVOHA WITNESS
    • ACT (CELITE NOT KAOLIN) WILL BE ARTIFICALLY PROLONGED
    • DOSE 1- 1 ML (1.4 MG)TEST DOSE, 2MILLION(280 MG)LOADING OVER 20-30 MIN THEN 500,000 (OR 70MG/HR)
    • DOSE 2 IS HALF OF ALL ABOVE
    • SE- RENAL DYFUNCTION, PHLEBITIS, DYSPNEA, BRONCHCON, MI STROKE, FEVER
  18. SEROTONIN
    • ENDOGENOUS VASOACTIVE SUBSTANCE (AUTOCOID)
    • NT OF N/V AND PAIN
    • 90% IN GI TRACT
    • IN CNS AND PLATELETS
    • META BY MONOAMINE OXIDASE
    • HT1=CEREBRAL VASOCON
    • HT2= VASOCON OF CORONARY
    • HT3= GI N/V
    • HT4 METOCLOPROMIDE
  19. SUMATRIPTAN
    • HT1 FOR MIGRAINES AND CLUTTERS HA
    • SQ 6 MG WITH T.5 2 HOURS MAY REPEAT
    • SE CORONARY VASOCON LEAD TO MI
  20. RIZATRIPTAN
    • HT1D MIGRAINES
    • 5-10 MG PO REPEAT 2HRS, MAD 30 MG IN 24 HRS, 1 MG MAX ON PROPRANONOL
    • SE MAO INCREASE CONCENTRATION, INCREASE BP, CORONARY VASPSAMS (BUT LESS)
  21. METHYSERGIDE
    • SEROTININ ANTOGONIST
    • LYSERIC ACID (LSD WITH NO CNS EFFECTS)
    • MIGRAINES MALABSORBTION AND DIARRHEA
    • SE RETROPERITONEAL, PLEUROPULMONARY, CORONARY, ENDOCARDIAL FIBROSIS
  22. CYPROHEPTADINE
    • LIKE H1 BLOCK BUT BLOCK SEROTININ AND HISTAMINE
    • TREAT SEASONAL ALLERIES, APPEITIE STIMULATION, SCHIZOPHRENIA, SPINAL CORD DAMAGE, HA, NELSON SYNDROME
  23. ONDANSETRON
    • 5HT3 ANTAGONIST
    • 4 MG Q2-5 MIN FOR N/V PERIOP
    • 0.15MG/KG PO OR 0.05-0.15MG/KG IV FOR KIDS
    • NO SEDATION
    • SE HA, DIARRHEA, UP LIVE ENZYMES
  24. DOLANSERTON
    • HT3 ANTAGONIST
    • PREVENT POST OP N/V BUT MUST GIVE 1 MIN A STOPPIN MEDS
    • 12.5MG IV OR 100MG PO (2 HOURS A OR)
    • KIDS
    • 1.2 MG/KG WITH MAX 100 MG PO
    • 0.35 MG/KG IV 15 MINS
    • SE= PROLONG QT, LOK, LOMAG,
  25. PALONOSETRON HYDROCHOLORIDE
    • GIVE TO PT IN CHEM IF ZOFRAN DIDN'T WORK
    • INCREASE COST BUT LO SE AND LAST LONGER THAN ZOFRAN
    • DOSE IV 0.25 MG OVER 30 MIN
    • PO 0.5 MG 1 HOUR A START OF CHEMO
    • 0.075 A INDUCTION IN OR
    • SE= QT PROLONG, HA, LOBP, BRADYCARD, ANXIETY, DIZZINESS, FATIGUE, WEAKNESS, CONSTIPATION, AND DIARRHEA, UP LIVE ENZ
  26. QUINIDINE
    • 100-600MG 4-6HR
    • START AT 200MG
    • MAX 3-4 GRAMS
  27. PROCAINAMIDE
    • 100MG Q5 MIN
    • MAX 5MG/KG
  28. LIDIOCAINE
    • 2MG/KG BOLUS
    • 1-5 MG/KG/MIN
  29. AMINODARONE
    • ACLS 300 MG THEN 150 MG
    • GTT START 150 MG OVER 10 MIN THEN 1 MG/MIN FOR 8HRS TO 0.5 MG/MIN FOR 18HRS
  30. SOTALOL
    • 80 MG BID
    • MAX IS 480-640MG OVER BID OR TID
  31. IBUTILIDE
    • PRE GIVE 2GR MAG AND 40 OF K
    • 1 MG >60KG
    • 0.01 MG<60KG MAY REPEAT IN 10 MINS
  32. ADENOSINE
    6 MG TO 12MG TO 12 MG WITH 30 MG MAX

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