RYE a2 RIERA gerrage g af i arterial blood gases before meals angiotensin-converting fengyme antidiuretic hormone attention-defci/hyperactivty disorder acid-fast bacillus alanine aminotransferase ante meridian antinuclear antibodies acetaminophen activated partial thrombo- plastin time adult respiratory distress syndrome acetylsalicylic acid Aspartate aminotransferase atrioventricular ‘wo times a day ‘bone marrow suppression brain natriuretic peptide blood pressure ‘benign prostatic hyperplasia Aid and electrolyee gram (gamma-aminobutyric acid {gastroesophageal reflux disease glomerular filtration rate ‘gamma-glutamyl transpeptidase {gastrointestinal ‘glucose tolerance test ‘genitourinary hydrogen ion hemoglobin A. glycoslated hemoglobin bicarbonate health-care professional/ provider high-density lipoproteins hematologic hemoglobin human immunodeficiency 3:hydrony-3-methylglutary- ‘coenayme A hour(s) hormone replacement therapy obsessive-compulsive disorder ‘ophthalmic over-the-counter ‘ounce(s) after meals patient-controlled analgesia pulmonary capillary wedge pressure Phosphodiesterase {ype 5 inhibitor pulmonary embolus post-meridian by mouth, orally as needed prostate-specific antigen prothrombin time peptic ulcer disease premature ventricular con- penpheral vascular disease ‘wery four times a day = z JF 2229 4 89 gogeg gee ge = 3 EESEHe BF ATRE BERG ROGAES gPResteaaga 88 i beats per minute blood urea nitrogen serum calcium cyclic adenosine monophosphate capsule ‘complete blood count cyclic guanosine ‘monophosphate congestive heart failure chloride ion ‘central nervous system cardiac output ‘chronic obstructive pulmonary disease ‘creatine phosphokinase controlled or continuous release colony: stimulating Factor; cerebrospinal fluid ‘computerized tomography ‘cardiovascular cerebrovascular accident central venous catheter hour of sleep/beckime Iypertersion Shydroxyerypramine- recepior agonst Schydronanptamine- Srrecepror antagonist inwracranial pressure ‘ jeceeeeca: jinternauional normalized intake and output ‘neraoeular invrathecal inaraverous potassium potassium chloride Klogram ter long-acing lactic dehydrogenase low-dersit lipoproteins ler furcton tes lactated Ringer’ solution ‘monoamine oxidase ‘monoamine ondase inhibicors sheuatoid antes ‘eceprr activator of miclear factor kappa 8 igand red blood eet ‘commended diy Sllowance ‘apidye movemene sipatory terol fonction teats Finan acid Shoat Sindenont-Lechionine seconds) ‘bling teremnin and norepineph- ‘ie euprake inibnore thorenee of breath ‘elution stained release ‘clctne serotonin reuptake inhbors immediatly 88 D/0.9% fi DNS ges gurpesgegpeg GPSEESSES2 FEPEEE central venous pressure chest ray ‘5% dextrose and normal saline solution (0.9% NaCl) 5% destrose and half ‘normal saline solution (0.45% Nacl) 5% dewrose in water dermatology diaberic ketoacidosis deciliter diabetes melitus disease- modulating antirheumatic drug eoryribonucleic acid deep vein thrombosis clectrocardiogram tlectroencephalogram 1, ear, nose, and throat Emergency Medical Services endocrine extrapyramidal symptoms extended-release end-stage renal disease smicrogram(s) metered dose inhaler riliequivalene metabolic riligram ‘magnesium ion ‘myocardial infarction minute(s) miscellaneous iliiter month(s) ‘magnetic resonance imaging ‘musculoskeletal sodium sodium chloride 0.9% NaCl 0.9% NaCI solution/normal NG NMDA ‘NPO NRT! NS(s) NSAIDs subeut (5) CORES SE GE saline neurologic nasogastric [Nemethy|-D-aspartate nothing by mouth nucleoside reverse transcrip- {ase inhibtor normal saline (solution) nonsteroidal ant inflammatory drugs subcutaneously suppository rable tuberculosis tablespoon(s) cyclic antidepressants three times a day tumor necrosis factor topically or topical ventricular fibrillation very low-density lipoproteins weal signs ventricular tachycardia white blood cell week(s)© Reno! insufficiency, renal failure, and proteinuria © Rash, Alopecia and Dermatitis © Photosensitivy eu UR Lia > Known allergy to ACE Inhibitors and Its chemical components History of Angloedema Pregnant women Billoteral Renol Artery Stenosis Hyperkalemia Severe kidney Disease Sever Liver Disease ACE Inhibitors induced cough Aortic Stenosis yvvvvyvyyvyYyYvyY Hypertrophic Cardiomyopathy Cees see Aad Orally Token 15 minutes, | 30-90 mnuees ‘© Ailof the ACE inhibkors ore acministered orally, Enelapri lso has the advantage of porenteral use (enoloprilat) It oral use Is not Feasible or rapid onset Is desirable ‘© These drugs are well absorbed, widely distributed, metebolized in the liver. and evcrated in the urine ond feces. © They nove been detected In breast milk, are known to {ross the placento, and have been assocloted with serious fetal abnormalities s0 they should not be used uring pregnancy. psc) Lanes Tela tela) © The risk of hypersensitivity reactions increases i these drugs are taken with allopurinol. There is o Fish of decreased ontinypertensive effects If token with nonsteroidal anti-inflammatory drugs: patients should be monitored, © The combination of drugs used to alter the RAAS Is. not recommended due to potentiolly serious adverse effects ond should not be combined with other ACE inhibitors, ARBS, or @ renin Inhibitor. )OD INTERACTION © Absorption of oral ACE inhibitors decreoses If they ‘re taken with food. They should be token on an ‘empty stomach 1 hour before or 2 hours after meals. NURSING CONSIDERATIONS Perform o thorough assessment of the = Medical History = Allergies to Food end Orugs = Kidney Dysfunction = Pregnancy Assess the Following = Vitel Signs = Fluid Status = Electrolyte levels such as Sodium and Potessium Watch Out for Signs of Hypotension = Ask pationt if he/she Is taking other cordiac medicines the luretles and ete. Assess Kidney Function Blood Urea Nitrogen 5-20 Creatinine Monitor Potassium Levels jerum Potassium = Patients with €KG, Hyperkalemia Is often seen os tall peaked T-woves Monitor Urine Output Hour 5 = 1.5mt/ag/hour pe 800 - 2000 mL ‘Check out for Angloedema = Press the patients shin ond assess for presence of deep ‘swelling beneath the shin’s surface Educate Patients to Check their BP ond HR = Provide heclth teaching of the Importonce of obtaining thelr ‘oun Blood pressure and Heart Rate even at home. Educate Patients to Avoid Foods with: = Solt Substieutes. = High potassium foods Potatoe! ve Beans, Bononas, Avocado ond For ACE Inhibitor induced cough: = Tel the patient who can’ tolerate cough causes by ACE Inhibitors to Immediately notify thelr physicions Educate to NOT SUDDENLY STOP TAKING THE mepication: = Physicians must be notified ifthe patient plans to stop tohing the medication becouse It could couse rebound hypotension.ANTI-HYPERTENSIVE AGENT: ACE Inhibitors eves un PRIL Usinoprit Enalopril Ramiprit Coptoprit uinoprit Perindopril Benozeprit inhibit AAAS (Renin-Anglotensin-Aldosterone System) Manages Blood Pressure primarily on the Kidneys: Activates Bradykinin | Commonly taken Orally Blocks conversion of Angiotensin | to Angiotensin il Allows retention of Potassium since RAAS Is blocked which causes production of Aldosterone Allows Excretion of Sodium and Water in the Body i “Ee t ° Bite Lowers Blood Pressure ~ Promotes Vosodiation because Angiotension Is blocked froleenst sa melor vasocensiritor Unt causes elevated oe. educes Afterload on the Left Ventricle of the Heart = Force tot the heart must overcome to open the aortic valve and push the blood volume out into the systemic circulation = Treats Systolic Dysfunction 8 Stroke Volume In each contraction ofthe heart Decreases Preload = Preloed Is the omount of @ ventricle has stretched ot the ‘end of Its filing phase on every contraction. Inhibits Aldosterone — nan Is oldosterone is dacransed, there Is Increased of serum potesshim ond excretion of water end sockim, Y Treatment of Post-myocardial infarction = Promotes healing and cardiac hypertrophy Proteinuria Reduction = Decrease pressure within the glomerulus minimizing proteln, leakage and avoids exacerbation to Chronic Kidney Disease. oe oe Alnsiocoema = when bradykinin Is high, Ie promotes vasodilation ond Increased in vascular permecbiity leading to leahoge of Ful oF iymph to surrounding tissues Couen = Elevated bradykinin couses stimulation of cough Reflon resulting In Ory Cough Ecevare POTASSIUM = inhibits reduce aldosterone potassium encration bIzzIness = Vasodilation due to Inhibited Angiotensin Conversion ‘couses Low blood pressure resulting to Lightheadedness or dizziness. ORTHOSTATIC HYPOTENSION = Vesodilation couses low bioos pressure = When 0 person stand up, gravity causes blood to poo! in the lower extremities, reducing the amount of blood returned to the heort, Blood vessels may not constrict adequately to ‘counteract this pooling effect © Reflex tachycardia © Chest pain © eva © Heart failure and Cardiac Arrhythmias © Gastrointestinal (Gi) irritation, ulcers, constipation e ver injuryINKIEIT CLASIFICATION ANTIBIOTICS Penicinillase ~ Sensible Natural Penicilins (narrow spectrum ‘Aminopenicillins {broad spectrum) Pentcinillase - Resistant (very narrow spectrum) Peaileillins. Nafcillin ‘Oxacillin I Dicloxad Antipseudamonal (extended spectrum) Tica Celt Carboxipenicil Carbenicillin Pipera Wert Ureidopeniciltins | Azlocilline s Mezlocillin Generation | Cofazalin Cephalexine | Cephapirin ae Cefadroxl | Cophadrine Cephalotin ‘i 3 Cefuroxime | Cofamandele | Cofprozil é ZF Generation | Cefoxitin Cofenicid ‘Cofmetazole : Cefotetan Cefaclor ; Cofoperazone | Ceftriaxone Ceftazidime i Generation | Cefpodoxime | Ceftizoxime _| Cefotaxime i Cefdinie Ceftiburen Cefixime Cefditaren # Generation _| Cefepime Cefpirame © S'Generation | Ceftaroline Carbapenems Enapenem | Doripenem | imipenem + Cylastatine ‘Menabactams Aztreonam Beta-Jactamase inhib. | Sulbactam Tatobactam Clavulanie Acid ‘No Glycopeptides Vancomycin Bacitracin lactam Teicoplanin Polymyxin 8 ‘Amino- Gentamycin Neomycin Streptomycin glyeosides ‘Amikacin Tobramycin. Tetracyclins Doxycycline Demeclocytin * Minocycline ‘Fetracyclin Tigecyclin Protein Qxazolidonones | Linezolid Synthesis Streptegramins | Quinupristin/Dalfopristin 505 | Cloramphenicol Mocrolides: Erythromycin. Azithromycin [ Clarithromycin Uncosamides Clindaniycin Lincomycin DNA Fluorquinolones “Ciprofloxacin Norfloxacin Levofloxacin | Ofloxacin ‘topoisomerases ‘Sparflaxacin Moxiffoxacin | Gemifloxacin | Enofloxacin Quinolones: Walidivic Acid Folic Acid | Sulfonamides Sulfamethoxazole | Ag Sulfadiazine | Sullasslazine | Sullisoxarole Synthesis (sMx) DHFR Inhibitors Trimethroprim (TMP) Pirymethamine DNA (damage) | Metronidazole mRNA synth, | RifampinActivated charcoal e Use for Non-specific poisonings e |t absorbs the drug in the gastric and intestinal tracts. e And it causes interruption of the entero-hepatic cycle.Drug Brands Usual Dose Maximum Dose Aspirin © Tab. Aspirin 300 mg 300 mg 4-6 hourly | 900 mg in divided © Tab. Ascard 75,150,300mg doses( analgesic © Tab. Disprin 300 mg dose) Tbuprofen| © Tab. Brufen 200,400,600 mg | 200-400 mg TDS | 1200 mg in 3 doses * Tab. Actifen 200,400,600 mg Flurbiprofen © Tab. Froben 50,100 mg 30-100mg BD | 300 mg in 2 doses Tab. Ansaid 100 mg Diclofenac Sodium © Tab. Artifen 25,50 mg 25-50 mg BD 150 mg per day * Tab. Dicloran 50 mg Tab. Voren 25, 50 mg Naproxen © Tab. Flexin 250,500 mg 250 mg BD 1000 mg in 2-3 ¢ Tab. Synflex 550 mg doses Piroxicam © Tab. Brexin 20 mg 20 mg OD 40 mg OD © Tab, Feldene 20 mg Nimesulide © Tab. Nims 100 mg 100 mg BD 400 mg in 2 doses Tab. Unix 100 mg Ketorolac © Inj. Toradol 10,30 mg/ml 15-30 mg 6-8h IV Paracetamol © Tab. Panadol 500 mg 500 mg 6-8 hourly | 4 gin 4 divided * Tab. Calpol 500 mg doses © Tab, Dispro! 500 mg Paracetamol + © Tab. Panadol Extra 1 Tab. BD/TDS caffeine Tab. Calpol Plus Paracetamol + © Tab. Wilgesic (450/35 mg) | 1 Tab. BD/TDS Orphenadrine © Tab. Wilgesic Forte (650/50mg) © Tab. Nuberol Forte (650/50mg) Paracetamol + © Tab. Codogesic 1 Tab. BD/TDS Codeine (500/15 mg) Tramaodol © Cap. Tramal 50 mg 50-100 mg 6h 400 mg in divided © Inj. Tramal 50 mg/ml IM/IV doses Tizanidine © = Temelin 2.4 mg 2-4 mg TDS 36 mg/day (Musle Relaxant) © Movax 2,4 mg Thiocolchicoside © Cap. Thiolax 4 mg 1-2 Cap. BD/TDS (Musle Relaxant) Cap. Muscoril 4 mgTypes of Anaesthesia *General Anaesthesia— — *Local Anaesthesia *Regional Anaesthesia ~ Spinal BR | Peripheral nerve block EpiduralCoronary Circulation to the Conduction System AA ‘Anode NVnode Bundle of kis Posterior fascicle of Left bundle branch AN node Bundle of His Fight bundle brench ‘Anterior fasicle ofleft bundle Posterior facil of Let bundle branch 5 Coronary Creation nd 1 ee XG lob Aedomialarea Conoaryatry (ai Cie [Game batt Welt ate BY Aoicrvll_—_ (eka decndgatery Classification of Antiarrhythmic Drugs Class 1 Sodium Channel blockers Class 1A Procainamide Quinidine isopyramide Class 1 Beta blockers : 2 Metoprolol Class i Potassium channel * | Amiodarone blockers © Sotalol * Dronedarone + ibutilide ‘Class 1V Calcium channel ° blockers : Adenosine Magnesium sulp!Medications - citalopram (celexa) - fluvoxamine - escitalopram (lexapro) - paroxetine (Paxil) - fluoxetine (Prozac) Bee) aM) - desvenlafaxine (rristiq) - venlafaxine (Effexor) - duloxetine (cymbalta) — - Milnacipran (savelia) - levomilnacipran (Fetzima) - bupropion (Wellbutrin) - mirtazapine (Remeron) - trazodone - vilazodone (viibrya) - vortioxetine (rintellix) - amitriptyline - imipramine - doxepin (siienor) - nortriptyline (Pamelor) - desipramine (Norpramin) - isocarboxazid (Marpian) - phenelzine (Narci) - selegiline patch (Emsam) - tranylcypromine (Parnate)Anti-diabetics in one-page seit Metformin E Linagliptin ¢.” Insulin “ @- Dapagliflozin E Glipizide First line T2DM med Avoid in eGFR<30 + DPP4 inhibitor * Good choice for renal impaired patients For both T1 and T2DM Need to teach injection tehcnique for SC pen SGLT2 inhibitor may increase risk of UTI GLP-1 agonist Given in SC injection * Sulphonylurea * High risk of hypoglycemiaANHIOLYTIC AND HYPNOTIC AGENTS BENZODIAZEPINES sum res ume= PAM = Allerazolom = Chlordiazepoxide = Clonazepam = Clorazepate - Diazepam = €stalozam ~ Flurazepam = Lorazepam = midazolom = Oxazepam = Quezepam = Temazepam = Triazolom ANE 15 @ Feeling of tension, nervousness, apprehension, or Feor thot sully Involves unpleasant reactions to 0 stimulus, whether actual or unknown when annlety becomes overwhelming or severe, it can, Inkerfere with the activities of daily living and lead to medical problems related te chronic stimulation of the sumpothetic nervous system. A severely anxious person may, For example, be afraid to leave the house or to interact with other people. In these: cases, treatment Is warranted. Aniolytic drugs ore rugs thot are used to lyse or break the Feeling of ennlety. Ecler ley ‘The loss of awareness and reaction to environmental stimull Is termed sedation. This condition may be desirable in patients who ore restless, nervous, irritable, oF overreacting to stimul Although sedation Is anvlolytic, e may frequently lead to drowsiness, venosis Is the extreme state of sedation, n which the person no longer senses or reacts to incoming stimull 1 Hypnotics ore used to help people Fall asleep by causing Sedation. Orups that are effective hypnotics act on the reticular activating system (RAS) and block the brain's response to Incoming stimu GABA Games Aminobutyric Acid ommo-ominobutyrle oc (y~aminobutyric acid, or GABA). {on omino acid, Is the major inbibtory neurotransmitter in the brain and nas been Found to modulate other neurotransmitter systems rather than to provide a direct stimulus. © rugs thot increose GABA function, such os benzodiazepines, are used to treat anwlety and to Induce sleep innblts too much excitatory = Reduces onniety = Relaxation = sleep = muscle retowant = Poin perception ‘Y BindswithGABA = When GABA Binds with Is receptor site, BDZ also binds thus: ‘causing the opening of the ligand-gated channels and allowing ‘more chloride lons to enter the neuron, = When chloride ions enter the neuron, it causes huperpolorization where in the inside of the neuron becomes more negative because of chloride Ions. Y Decreased Firing potentiol = ~ unen the Inside ofthe neuron is more nepetive, the fring potential decreased or tranguilzed thus, inhibitory mechanism have occurred already. = These erugs act in the limbic system and the RAS to mohe ‘gemma-aminobutyric ocid (GABA) more effective, cousing Interference with neuron Firing 'Y Sedation ond drowsiness. ? ~ umen the electrical activity of the bal s decreoses, xtreme sedation and feetng of steepness coud cou wtich is very helpful or patients with ene ADVERSE EFFECTS Depression Lethoray Blurred Vision Sleep driving Headaches. Apathy Ught-headedness Amnesio Confusion. Tis poradonical encieatory we ceccccccce GASTROINTESTINAL SYSTEM: © pry mouthINHIBIT CLASIFICATION ANTIBIOTICS Penicinillase ~ Sensible Natural Peniciliins Benzathine (IV, IM) (arrow spectrum) ‘Aminopenicillins _ | Ampicillin {road spectrum) | Amoxicillin Penicinillase — Resistant (very narrow spectrum) Penicillins Nafeillin Oxacillin Dicloxacillin Antipseudomonal extended spectrum) Ticarcillin cell Carboxipenicillins _| Carbenici Piperacillin Wall Ureidopenicillins | Azlocillin Mezlocillin : 1° Generation | Cefazolin Cephalexine | Cephapirin y Cofadroxil Cophadrine Cephalotin n | Beta 2 i: \lteuceansd Cefuroxime | Cefamandole | Cefprozil h 2° Generation Cefoxitin Cefonicid Cefmetazole 2 Cefoteten Cefaclor 4 Cephalosporins ‘Cefoperazone | Ceftriaxone Ceftazidime i 3°Generation —_[ Cefpodoxime Cefotaxime 5 Cefdinir Ceftibuten Cefixime Cefditoren ‘4 Generation Cefepime Cefpirome * Se Generation _| Ceftaroline Carbapenems Meropenem Ertapenem | Doripenem | imipenem + Cylastatine Moenobactams | Aztreonam Beta-lactamase inhib. | Sulbactam Tazobactam Clavulanic Acid Glycopeptides Vancomycin Bacitracin lactam Teicoplanin Polymyxin 8 ‘Amino- Gentamycin Neomycin ‘Streptomycin 30S | glycosides ‘Amikacin Tobramycin Tetracyclins Doxycycline Demeclocylin * Minocycline Tetracyclin Tigecyclin Protein Oxazolidonones | Linezolid Synthesis ‘Streptogramins | Quinupristin/Dalfopri 50S | Cloramphenicol Macrolides Erythromycin ‘Auithromycin Clarithromycin Lincosamides Clindamycin Lincomycin DNA Fluorquinolones Giprofioxacin Norfloxacin. levofloxacin | Ofloxacin topoisomerases ‘Spariloxacin Moxifloxacin ‘Gemifloxacin | Enofloxacin Quinolones Nalidixic Acid Folic Acid | Sulfonamides ‘Sulfamethoxazole | AgSulfadiazine | Sulfasalazine | Sulfisoxazole Synthesis (sm) DHFR inhibitors Trimethroprim (TMP) Pirymethamine DNA (damage) | Metronidazole mRNA synth, | RifampimPENICILLINS Examples: Amoxicillin Most effective against Gram + bacteria: *Strep throat, Staph, Clostridium, Neisseria, Listeria, Ear infections Pregnancy: Safe Adverse Effects: Gl effects, hypersensitivity, candidiasis VANCOMYCIN Effective against Gram + bacteria: C-diff (PO Vanc), Endocarditis, MRSA. Adverse effects: Nephrotoxic and Ototoxic Unique adverse effect: | Synaromlel Gel clini soni this happens) AMINOGLYCOSIDES Examples: Gentamycin Effective against Gram + and Gram - bacteria: Serious infection, Sepsis, Meningitis Adverse Effects: Nephrotoxic, Ototoxic, DO NOT give to patients with Myasthenia Gravis! Adverse Effects: Photosensitivity Adverse Effects: Achilles tendon prophylaxis, PID, Acne vulgaris Pregnancy and breastfeeding CEPHALOSPORINS Examples: Cephalexin, Cefuroxime, Ceftriaxone Effective for Gram + and Gram - bacteria (1st, 2nd, and 3rd generations): Staph, Strep, Bronchitis, UT!, Pneumonia Pregnancy: Safe Adverse Effects; 2. due to cross- icles 71s Arerol 1s) QUINOLINES Examples: Ciproflaxin, Levofloxacin Effective against Gram + and Gram - bacteria: Anthrax, Campylobacter, Salmonella, Pneumonia Reserve for SEVERE infections. rupture, CNS toxicity TETRACYCLINES Examples: Doxycycline, Minocycline Effective against Gram + and Ley e Thea erect cl LE) NOT SAFE NOT SAFE for children!Antibiotics Administration © With a full glass of water With or just after food empty stomach Flucloxacillin Clindamycin Metronidazole Oxytetracycline Pivmecillinam Phenoxymethylpenicillin Doxyeycline Metronidazole Nitrofurantoin Giseofulvin Ampicillin Itraconazole Fosfomycin Avoid milk, indigestion remedies, zinc or iron containing meds 2 hours before or after Avoid indigestion remedies 2 hours before or after Doxycycline Oxytetracycline Azithromycin Tabs Ciprofloxacin Minocycline TetracyclineAntibiotics and counselling points Taken on an empty RIC ta | ken with or just Bia Coles: |Penicillin Ampicillin Bacitracin Cephalosporin Tetracycline Streptomycin Sulfa Drug Rifampicin Quinolones Inhibits Cell Wall Synthesis Inhibits Cell Wall Synthesis. Inhibits Cel] Wall Synthesis Inhibits Cell Wall Synthesis Inhibits Protein Synthesis Inhibits Protein Synthesis Inhibit Cell Metabolism InhibitsRNA Synthesis Inhibits DNA Synthesis TARGET BACTERIA Gram Positive Bacteria Broad Spectrum Gram Positive Bacteria As Skin Ointment Gram Positive Bacteria Broad Spectrum Gram Negative Bacteria and Tuberculosis Bacterial Meningitis And Urinary Tract Infections Gram Positive Bacteria And Gram Negative Bacteria Urinary Tract InfectionsANTICOAGS VS. ANTIPLATELETS ANTICOAGS) ANTIPLATELETS Keep blood clots from forming by keeping blood platelets from sticking together Sl lows the clotting of blood = Cag TRICK ANT | Platelet think ANT! Platelets EXAMPLES: Aspirin Clopidogrel TicagrelorAnticoagulant Drugs Vitamin K Antagonist | Route Indications for Use Warfarin (Coumadin) Prevention of venous thrombosis, PE, | Bleeding prevention of thrombosis in patients with prosthetic heart valves, and thrombosis in atrial fibrillation Factor Xa and Thrombin Inkibitors Indications for Use Adverse Effects Heparin Iv, PE, evolving stroke; DVT, adjunct to | Bleeding, HIT, subcutanzously | thrombolytic therapy in acute MI__| thrombocytopenia Low Molecular Weight Heparins Dalteparin (Fragmin) | subcutaneously } Prevention and treatment of DVT, PE | Bleeding eS eS ee er Indications for Use Treatment/prevention of Bleeding thrombosis in patients with HIT Bivalirudin IV ACS, PCI Bleeding, back pain, (Angiomax) nausea Lepirudin (Refludan) | 1V Argatroban (Acova) Treatment/prevention of thrombosis | Bleeding in patients with HIT Desirudin (Iprivask) | subcutaneously | Prevention of DVT in patients Bleeding undergoing hip replacement surgery Atrial fibrillation (nonvalvular GI bleed, abdominal etiology) pain, dyspepsia Indications for Use Atrial fibrillation (non-valvular Bleeding etiology Dabigatran (Pradaxa) | PO Apixaban(Eliquis) | PO Fondaparinux subcutaneously (Arixtra) Acute DVT treatment (in conjunction with warfarin), DVT prophylaxis, acute PE ACS, PCI Bleeding, thrombocytopenia Bivalirudin Iv (Angiomax) Rivaroxaban (Xarelto) | PO DVT prophylaxis, Atrial fibrillation Bleeding, back pain, nauseaVitamin K Romazicon (Flumazenil) ..Calcium Gluconate .. Protamine Sulfate Mucomyst Coumadin Benzodiazepines Magnesium Sulfate... Tylenol... Opiates........Narcotic analgesics, heroin morphine, Narcan Cholinergic Meds.........Atropine, pralidoxime (2-PAM) DN KA i rar eccesscrcscratonttcs spnreteaeaicenscetesceseehersieces Digiband ..n-Acetylcysteine ..Deferoxamine Alcohol Withdrawal. Librium Anticholinergics.. ..Physostigmine Beta Blockers.. ....Glucagon Methotrexate. -Leucovorin Anticoagulants. ..Vitamin K, FFP Sodium bicarbonate Calcium, glucagon, insulin Aspirin Cyanide. -Tydroxycobalamin, sodium thiosulfate Hydrofluoric acid ..Calcium Gluconate US UMN B TW sas caccsscevaissycasssccesececsassssoasecsosonssseseacesssssssysane Glucose Isoniazid Deferoxamine INGER Ra IN sores scorers snc case cc sevee si ess ck vorceennntccteees Ethanol Ethylene glycol. ..Fomepizole, ethanol Methemoglobin -+++..-..Methylene blue ..Sodium bicarbonate Tricyclic antidepressant..fe) 20) Antidote Acetaminophen Anticholinergics Anticoagulants Aspirin Beta blockers Benzodiazepines Calcium channel blockers Carbon monoxide Cholinergics Cyanide Digoxin Heparin Heavy metals + Arsenic + Copper + Lead + Mercury Hydrofluoric acid Insulin Iron Isoniazid Methanol Ethylene glyco! Methemoglobin Opioids Serotonin reuptake inhibitors Sulfonylurea Tricyclic antidepressant Dae el ret oe N-acetylcysteine Physostigmine Vitamin K, FFP Sodium bicarbonate Glucagon, insulin Flumazenil Calcium, glucagon, insulin Oxygen Atropine, pralidoxime (2-PAM) Hydroxycobalamin, amyl nitrite, sodium thiosulfate Digoxin FAB Protamine Dimercaprol EDTA Penicillamine Succimer (DMSA) Calcium gluconate Glucose Deferoxamine Pyridoxine Ethanol Fomepizole, ethanol Methylene blue Naloxone Cyproheptadine Octreotide, glucose Sodium bicarbonateOPIOIDS WARFARIN HEPARIN BETA BLOCKERS BENZODIAZEPINE ACETAMINOPHEN MAGNESIUM SULFATE IRON TOXICITY Memory Tricks Naloxone NO more Opioids (Narcan) (Narcan > Opioids) ce During WAR, Vitamin i Miramatis Kills WARFavin Protamine You will need HELP from Sulfate a PRO to stop bleeding out Gluesaen Beta blockers be GONe 8 with GlucaGON Flumazenil | FLU fast in my mercedes BENZ Acetylcysteine — ACETaminophen > ACETyleysteine Calcium MAGgie CALLs for help! Gluconate (MAGnesium > CALcium) DeFERoxamine > FERrous means “containing iron" DeferoxamineDRUGS TOXICITY ANTIDOTES DRUGS Paracetamol Anticholinesterase Benzodiazepines Heparin Beta Blockers | I, Iron CCBs Warfarin Anticholinergics Cyanide Digoxin Dopamine Tricylclic Antidepressant « Narcotics Insulin Reaction Cyclophosphamide ANTIDOTE * Acetylcysteine * Atropine sulphate * Flumazenil * Glucagon * Glucagon * Vitamin K © Sodium Nitrate * Digibind * Phentolamine * Protamine sulfate * Deferoxamine * Physostigmine Physostigmine * Naloxone * Glucose * Mesna6 types of antiemetics “GYM HANDS” Glucocorticoid (G) Antimuscarinic (M) * Dexamethasone * Scopolamine hydrobromide (rigoedine) Antihistamine (H) NK1 Antagonist (N) * Diphenhydramine * Aprepitant * Dimenhydrinate * Fosaprepitant « Promethazine * Meclizine * Rolapitant Dopamine 5-HT3 Antagonist Antagonist (D) (S) * Prochlorperazine * Chlorpromazine * Ondansetron * Droperidol * Granisetron * Haloperidol * Dolasetron * Metoclopramide * Palonosetroncarbamazepine Hyponatraemia Enzyme Inducing Carbamazepine Phenobarbital Phenytoin Topiramate {>200mg daily) Inducers Reduce! Elevated liver enzymes ADRs with common anti epileptic drugs Carbamazepine Rashes. Leucopenia Oedema Fecarl|ineh . Pct Potentially life threatening Topiramate Acute myopia Weight loss PI re reactions : Associated with: ee ee ae eee Lamotrigine Phenytoin Electrolyte Changes Impaired bone health Category | Must be prescribed by brand Phenobarbital Primidone Carbamazepine 3Ps and a C! Caution Phenytoin pee Small increased risk of suicidal thoughts and Weight loss/gain behaviour Blood Dyscrasia's Sodium Valproate Clin women and girls of childbearing potential unless conditions of Pregnancy Prevention Programme are met Hypersensitivity SyndromeAntihistamines H1-receptor antagonist Non Sedating Adverse Effects Sedating Cetirizine/Loratadine Cinnarizine Foxofenadine pied Vision Hydroxyzine Cetirizine Angio-cedema Chlorphenamine ‘Acrivastine Loratadine Mizolastine Dry Mouth Promethazine Urinary Retention Cross the blood brain barrier Even with non-sedat antihistamines some people | Renal Impairment Cetirizine eGFR 30-50 = Half Dose Treatment of allergy such as hay fever 30% from baseline. Angiotensin Receptor Blockers (ARBs) Candesartan ‘amg OD 16mg OD ‘© Contraindicated in pregnancy and Irbesartan 150mg OD 300mg OD bilateral renal artery stenosis. Losartan 50mg 0D 100mg OD Telmisartan 20mg 0D 80mg OD Valsartan 80mg 00 160mg OD Olmesartan 20mg 0D 40mg OD Miscellaneous Prazosin (Alpha Blocker) 0.5mg BD 10mg BD © Doxazosin is useful in patient Doxazosin mg 0D 16mg OD with benign prostatic hypertrophy. Labeltalol 100mg BD 800mg TDS In elderly, start Labetolol with Carvedilol 125mg 0D | 50mg 0D 50mg BD. Methyldopa 125mg BD gm BDFg PHareacolooy, > aes AAPA IAN i a! ® erooo PRESSURE oe © s. ® otra ® ® s Aniatortor Blocker cats Owugetee BLOCKER + + Gent) (-lall-cled) — Gpine,-agn — C-serm ds, enalapnl Arkenolol -2em) = ¥AV0.2192) amlddiewne Fucosernde R ¥ (oA) ¥ (moa) wy (mor) Yienos) reuert Conversion Blocks the Revenk co eee OF Angrorensin etreck Of tons movement diuresis. Pea eS ee Bois KN Cog Curd J XX. Revents ee CoN magwinare. pes} Vasoconsinchon 4. Angquoedenna Ae Brodycardia A.Orhosiovic GEGLS 2. Lough 2 Does lnyeokension 2. ro. 3.0% 3. HYPECYEMIA 2. Croaness 3. * wyPoension 3. Gradycodie, Sash A. Mon-Seleckive = vee “Wuaitiaa! tate tg 0 { \ i 3, mono GPP oS RC 2. PkedU 2. Momrtor a. onder 9) cose xo Crorge ECG Berhorn 3. Mondor a BPP mentors Slowly“ elecholyieg ae i ColiPau ES aes Risk reduction for ischemic: stroke, TIA, stable angina, ACS, PAD ACS after PCI, MI, or stroke, PAD (Effient) (Brilinta) ACS after PCI ACS after PCI Bleeding, dyspnea Ticlopidine (Ticlid) Risk reduction for stroke in patients intolerant of aspirin Thrombocytopenia, neutropenia, TTP PDE Jahibitors. Route | Indications for Use ‘After heart valve replacement (used with warfarin) PAD, intermittent claudication I Adverse Effects Headache, dizziness, nausea, Headache, diarrhea, flushing, hypatens Excessive bleeding, including bleeding from the GI and urinary tracts and retroperitoneum Excessive bleeding, including bleed- ing from the GI and urinary tracts Excessive bleeding{ Antiplatelets are not usally prescribed for PRIMARY PREVENTION of cardiovascular disease ACS “ Aspirin - Initially 300mg 1 75mg thereafter indefinitely i DAPT aspirin with: { Clopidogrel 75mg OD 1 1 1 1 \ Clopidogrel 75mg OD Those at higher risk of ischaemic events: Rivaroxaban 2.5mg AND aspirin 75mg OD Ticagrelor 90 mg BD (40mg 8D if >12 months duration) Prasugrel 5mg OD ee eee .. (10mg if <75 years old and >60kg) ? wee eee eee ea Stroke, or transient / Percutaneous coronary ischaemic attack (TIA) alctavc-tildco)a) Clopidogrel 75mg OD * | Ticagrelor 90mg BD i 6 ae ' If clopidogrel not tolerated: | i een 75mg OD with ‘ 1 Aspitin75mq OD I ; clopidogrel 75mg OD for ' “ nal ' 6 months 1 iMR Dipyridamole 200mg BD witht 1 Those with high ischaemic risk who have 1 aspirin { | tolerated without issues eon be continued for ! t x 36 months SMR Dipyridamole monotherapy / ee ere steer or edeatonl paposes ely. Cont smaca prationesadice, Every ots mde erere the ntomation "atest gicence, and check Sones and gudeines withie resources such sate BNF and ICEAntiseizure Drugs Tonic-clonic* & Absence Broad . Partial seizures Seizures Spectrum Adjunct Carbamazepine Ethosuximide Valproic acid (Lamotrigine) Phenytoin Broad Spect HI n Pherberbita © 5tad Spectrums) (Cionazenam”) (Gahanentin) (& Broad Spectrums) * Lorazepam or Diazepam: i.v. for Rx tonic-clonic status epilepticus ** Clonazepam is an alternative drug due to undesireable sedation & toleranceANTIDOTES Beta blockers::::-:::: Glucagon DIQOXINy se rete bree eg Digiband WOT n= ies Vitamin K Heparin: +... 2-2 Protamine Sulfate Benzodiazepines +++. > Flumazenil Magnesium sulfate ---- - Calcium Gluconate Cholinergic meds: ------ Atropine,Pralidoxime Anti-Cholinergic meds: - - - Physostigmine TCA antidepressants: - - - Sodium bicarbonate Acetaminophen: ------- Acetadote Aspirin: --- +++ +2 -e--- Sodium bicarbonate Opioids: :4:2:%::2:::- Naloxone Insulin... +--+ +e eee eee Glucose Methotrexate-------- Leucovorin ROM COXICICV 5 = ae on Deferoxamine Eead toxicity = =~ Succimer‘Aanticholinergics + “Antagonze the ations of Ach, top sympathetic action: "Block cholinergic receptors in ung > bronchodistion Adresse eft Dry mouth, cough, hoarseness, bitter taste auelnteractions: Use with other antichelinerls wil lead to adive “anticholinergic adverse effects Patent Edueaton: Proper use of 0, SEE Wash mouth ater use iter taste continues Selectively agoize Beta-2 adrenergic receptors fon smooth muscle ofthe ung and causes bronehodistion,eressed cla motity When given by inhalation, Beta? agonist re ‘the most effective drugs for acute bronchospasm baled: ‘Mineal system tony beeause of mite absoraton ater inhalation ¥ ¥ For rescue & For rophvass of cute weatment enure | exacerbations eel re “was see “dry powered inhalers levabuterolforcardive || therapeutic effects ast patents pte 2 hours ‘Nebuized rmetered || -siow onset of action for oseinhalers (wok) |] MAINTENANCE ON “Rapid onset of action, ‘BlackBox Warning, uration 2-6 hours stncreased riskot us fethmarelated deaths rescue drugusedas || “Not first ine needed to rleve “Must ALWAYS be given ‘ongoing stack with an inhale ster Severs induced “contraindicated for use bronchospasm: prevent || alone in asthma patents stuck i + ‘duos: ¥ “Rare becaute medications ae inhaled “Palpatons and tachycardia (because of spill beat acthaton), headaches, emer, nervousness, ‘restlessness Drug interactions *concurent use with nonselective beta blockers may Inhibit the ronchodiation effet of SABAS and LABAS “Avoid monoamine enidaze inhibitors (MOAI) within 1 days ofbepinning therapy if posible. Patent Education: “Appropriate ue finale / Limi use of cffelnated ‘roducts / Immediately report dificuty breathing, ‘hart palpitations tremer, voting, nervousness, ison changes “Limit OTC sympathomimetic take 20-0 minutes before exercie| Tenia eid ete Bayo See a cea eter ised avalos amcaaloe Sonic ro ee esa neni wean ice —- ecanee aeon oes || teen orient: Poussin bocce Se! oe ea ernment Saunt acest nac em ¥ EE faa Aes, ede, ‘ney Se + a FEE poten ari twratroium coon Cat SS nc / 12 ¥ ‘oo sone Contain tonchodiion Teor Combined in a MOI canter *Do not give to patents with peanut allergies! “Tel patients to ose their eyes when using Cause of superior effiacy of his drug combo: Cauca $ | Monoclonal antibodies ‘LSuonuesinflammation “decrease syesis& release of inlammatory mediators decrease infitration & {ety of infammatory cls “cecrese edema of aoway rucosa which reduces bronchial reactivity {aternathe). Used for rophylons, May be most effective in patients with severe allergies ‘action: Lelottone (immune ‘tesponse mediator) receptor ‘2.Dscreac aireay ones antagonists production Reduced ncceasenumber otiata.2 | | bronchocontriion, mucus acento Acesnonsiveness | | production, alway edema oete2 agonists SABAS 5 perry Prophylans & maimenance Adverse effets: treatment for asthma ‘Used for prophyans not reseve) ‘ven on aed schedule 1" ine of “elevated Ts (monitor) Headache, nausea, darhes, aelat with ver impsiement + ‘tion, Binds to the Immunoglobulin (ae) which prevent inflammation and dampens ‘the bodys response to alergens that rigger asthma ilictheran Novel approach o treatment ¥ ‘Omalizumab + ole ‘trauma, infection) Usualy 57 ays “Given as supplemental to inhaled comaecncnen «EE[~~~ | = VV | NORMAL BREATHING RATE +PATTERN OECREASED RESPIRATORY RATE INCREASED RESPIRATORY RATE ABSENCE OF BREATHING OEEP RESPIRATIONS/ BREATHING INCREASE AND OECREASE IN RESPIRATIONS WITH APNEA RAPIO GASPS WITH SHORT PAUSES BETWEEN SETS TACHYPNEA AND HYPERPNEA PROLONGED INSPIRATION AND: SHORTENEO EXPIRATIONThe heart muscle can't pump enough blood to meet the body's needs (impairs the ability of the ventricles to fill or eject properly) LEFT-SIDED: Dyspnea, weight gain, crackles, etc. \\ S Left side think Lungs SIGNS & SYMPTOMS RIGHT-SIDED: Edema, ascites, JVD, etc. #25 ight side think Rest of the body t B-type natriuretic peptides (BNP) TREATMENT MEDICATIONS: DIET MODIFICATIONS: * Diuretics * Fluid restrictions * ACE inhibitors * 4 Sodium, fat, cholesterol * Beta blockers * Digoxin_ CHILD VACCINATIONS © VACCINE - BCG + Oral Polio Vaccine TIMING + At Birth + Pentavax Vaccine * Pneumococcal vaccine * Oral Polio Vaccine + Rota Virus Vaccine * Pentavax Vaccine * Pneumococcal vaccine * Oral Polio Vaccine + Rota Virus Vaccine Week * Injectable Polio Vaccine * Pentavax Vaccine + Pneumococcal vaccine * Oral Polio Vaccine Week + 9th * Inj. Typhoid Months * Injectable Polio Vaccine * Inj.Measies + MMR Vaccine ¢ Inj.Typhoid(Booster) * 18th + DPT Vaccine Months * Oral Polio Vaccine p * IMand Oral > Syears ‘> DT and OPV + 0.5 ml and 2 Drops|intensity Low Moderate High Statin Therapy Definition Dally dose lowers LDL-C by <30%, on average Daily dose lowers LDL-C by approximately 30% to <50%, on average Daily dose lowers LDL-C by approximately 250%, on average Dosage Simvastatin 10 mg Pravastatin 10-20 mg Lovastatin 20 mg Fluvastatin 20-40 mg Pitavastatin 1 mg Atorvastatin 10-20 mg Rosuvastatin 5-10 mg Simvastatin 20-40 mg Pravastatin 40-80 mg Lovastatin 40 mg Fluvastatin XL 80 mg Fluvastatin 40 mg bid Pitavastatin 2-4 mg Atorvastatin 40-80 ma Rosuvastatin 20-40 ma‘CHRONIC OBSTRUCTIVE PULMONARY DISEASE et ian a (aa wane 2, Croat cman ting ion seat Toe ers ime udu SS peas eeceee, MUST aus Alo tan, Rio oxecaben cemeniier ‘ora, “Depot nny ei 5 met eer oom Sloper” |S Sipe + Nem Pham Te "Eat cater (ny 1 dew rein) acne a Do Cord mes do hip echng yn 5 tees deren Sy rev conan, Sina/SLES Fila taba ee st pnt ~ 1 a = on Sane oto fate ant shonwte ke a cao | = oreo : oan 6019 1 ie [FEV] 2 80% predic — co Sevore ee ee ae De oA RAE TStenind ar 10d eee ee en sa hamine oe weenie | by aa | MAMIE = 1800 rps Peet eae "Paste wait 2a een ot 2 Shoreeaee copes | pre tees . aie Eicon teeters Moores sn £070 a aes ime | focae wan, HOF pi) Ske wails ne Eom + Rehabs Secon, | SSirecietee | > SeTilaedemitreeoe ‘kt tin dot = Mae os eho) 2 B00 Corrente, Panaborbe, Frena Ranp yet Sin Paws nt Cm, sc ata onsale Tae Raa “eipa raia Rear rediae aaa 1, Tamdearbme tec | 1s Pc caper te path 1s Hey tn cael dew Se 2 Spoveepamavey |" Eien mo omer angen GRE” | 1 Aeon dee does | 1. mr apm hom nr 2 acerca se 2. fncreonbmoONck 2, Sie nin ele Stroman pti ate EN ROW/omr | aimaesiowper | 5 tee owortuae Nt iy 2. titiwrdowor ins | 2, Renavey nl ty 4S foldtrat imal Oe | Range” | Hae FY 1 Rat et exe event 3. eon donber me A Yee ee ale Smngiscaats | 5 Spncopate RATES Se FINEST a waar | Econ) dm aomer| Mra act | 4. Gog NOT ereEtc zides Hydrochlorothiazide Chlorthalidone Indapamide Captopril Enalapril Lisinopril Perindopril Ramipril Fosinopril Quinapril Trandolapril ANTIHYPERTENSIVE DRUGS (1) Furosemide (others) Losartan Candesartan Valsartan Telmisartan Inbesartan Olmesartan Coen) Bocukanls Spironolactone Eplerenone Amiloride Metoprolol Atenolol (others) Suc: asia Labetalol Carvedilol Clonidine Methyldopa Phentolamine Phenoxybenzamine| Contd.CLASSIFICATION OF ANTICANCER DRUGS [ALKYLATING AGENTS | | ANTIMETABOLITES 1, Mechlorethamine 2. ‘Cyclophosphamide | Folate antagonist 3. iMesfamide ye 4. Chiorambucit Purine antagonist 5. Melphaian, Busulfan ||+ 6-Mercaptopurine 6 Carmustine + Fludarabine, Cladribine Y, toast _Pytimiaine antagonist & Dacabacne | + horus er fo.cispiain oaipiain | > Capectabine 11, Carboplatin + Gemcitabine on ans Ree ig —— CAMPOTHECIN 1. Procarbazine pers al A |__ANALOGUES _| sp — T 1. Topotecan ~Bactnomyein 2 nnotecan 2. Doxorubicin A~C->M ce i (Adriamycin) | Vv 2 eae 7 Pasose T Vinesine #8 A re Leen in; Mitonapen |} 3. Vinorelbine 8._Morantone