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Pharmacology

Common Cold Symptomatic & Treatment

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Disclaimer:

This is not a prescription. Using medicines without the guidance of a licensed provider  can be lethal.

 

 AnaIgesics

2. Combination products of

  • Antihistamine
  • Decongestant

3.  Cough maybe due to

  • Nasal obstruction or
  • Post nasal drip

For cough dextromethorphan

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Categories
Microbiology Pharmacology Surgery

Treatment of Methicillin Resistant S. Aureus Bacteremia

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Disclaimer: this is not a prescription. Using medicines without the guidance of a licensed provider  can be lethal.

This is not a prescription for any specific patient. For methicillin RESISTANT (MRSA) staphylococci following antimicrobial therapy can be used:

Vancomycin 15-20mg/kg IV every 8 to 12 hours. Not to exceed 2 g per dose. Or Daptomycin 6-10 mg/kg IV once daily.

Alternative agents can be:

Ceftaroline 600 mg IV every 12 hours

Telavancin 10 mg/kg IV once daily

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Categories
Microbiology Pharmacology Surgery

Treatment of Methicillin Sensitive S.Aureus Bacteremia

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Disclaimer:

This is not a prescription. Using medicines without the guidance of a licensed provider  can be lethal

This is not a prescription for any specific patient.

For methicillin sensitive staphylococci following antimicrobial therapy can be used:

  1.  Nafcillin 2g IV every 4h. Or
  2.  Oxacillin 2g IV every 4h. Or
  3.  Flucloxacillin 2g IV every 6h.

If the pathogens are penicillin sensitive then penicillin 4 million units IV every 4h is the drug of choice. Keep in mind that mostly the isolates are not penicillin sensitive.

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Categories
Microbiology Pharmacology

Empiric Treatment of Staphylococcus Bacteremia

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Disclaimer:

This is not a prescription. Using medicines without the guidance of a licensed provider  can be lethal

This is not a prescription for any specific patient.

Staphylococcus Aureus is the leading cause of community and hospital-acquired bacteremia. Treatment failure is common in S. Aureus patients, especially in MRSA infected patient. Treatment failure means:

  •  Death within 30 days following treatment. Or,
  •  Persistent bacteremia after 10 days of suitable therapy. Or,
  •  Recurrence of bacteremia after 60 days of discontinuing the therapy.

The treatment approach is to remove the source (catheter etc.) and antimicrobial therapy. Therapy needs culture and susceptibility tests. While waiting for these the empiric therapy can be:

Vancomycin (15-20 mg/kg every 8-12 h, not to exceed 2g/dose)

Daptomycin (6 mg/kg once daily) is a reasonable alternative.

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Categories
Pharmacology

Treatment of Staphylococcal Scalded Skin Syndrome (SSSS) without Systemic Findings.

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Disclaimer:

This is not a prescription. Using medicines without the guidance of a licensed provider  can be lethal.

Usually ne d hospitalization for IV drugs Vancomycin or Clindamycin for MRSA Flucloxacillin (Penicillinase  resistant anti-staph) . Nafcillin or oxacillin can  be used too.

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Categories
Pharmacology

Treatment of Acute Otitis Media (AOM)

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Disclaimer:

This is not a prescription. Using medicines without the guidance of a licensed provider  can be lethal.

Begin with Observation and supportive care. Unresolved case, amoxicillin for 10 days.Resistant cases, amoxicillin plus clavulanic acid.Recurrent cases may need tympanic tubes for drainage

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Categories
Pharmacology

Strep Throat Treatment

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Disclaimer:

This is not a prescription. Using medicines without the guidance of a licensed provider  can be lethal.

Strep throat TX: Penicillin for 10 days. Erythromycin if  allergic to penicillin.

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    Categories
    Pharmacology

    Core Set of Anti-TB Drugs

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    Disclaimer:

    This is not a prescription. Using medicines without the guidance of a licensed provider  can be lethal.

    Core set of anti-TB drugs is:

    1. Isoniazid (INH)
    2. Rifampin (RIF)
    3. Ethambutol (EMB)
    4. Pyrazinamide (PZA).

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    Categories
    Pharmacology

    Vancomycin Running Over Pneumococci

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    Disclaimer:

    This is not a prescription. Using medicines without the guidance of a licensed provider  can be lethal.

    1. Penicillin  (be aware that resistance is common)
    2. Vancomycin
    3. Ceftriaxone (Dont administer infants due to albumin binding.)

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    Categories
    Pharmacology

    Microbiota Alteration Due to Antimicrobial Therapy

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    Disclaimer:

    This is not a prescription. Using medicines without the guidance of a licensed provider  can be lethal

    Only a few examples are given here:

    1. In hospitalized patients on antimicrobial therapy, normal flora is suppressed as well. This partial void of normal flora allows prevalent pathogens in the environment to fill in. This results in the patient carrying super-bugs (mostly drug resistant) e.g. Staphylococci Aureus and Pseudomonas.
    2. Women taking oral antimicrobials can have their vaginal microbiota partially suppressed resulting in abundant growth of candida.Persons
    3. receiving antimicrobial therapy may end up with the suppressed normal flora of the gut. This can result in the establishment of the drug-resistant pathogens. Which, in turn, can cause severe enterocolitis. An example is diarrhea by clostridium dificille.

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    Categories
    Pharmacology

    Treatment of Uncomplicated Candida Vulvovaginitis.

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    Disclaimer:

    This is not a prescription. Using medicines without the guidance of a licensed provider  can be lethal.

     

    1. Healthy, non-pregnant, immunocompetent woman.
    2. Sporadic infection.
    3. Mild to moderate signs  and symptoms.

            A single dose of  oral Fluconazole 150 mg.

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    Categories
    Pharmacology

    Treatment of Symptomatic Candida Vulvovaginitis in Pregnant Women

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    Disclaimer:

    This is not a prescription. Using medicines without the guidance of a licensed provider  can be lethal.

    Topical application of  Imidazole (clotrimazole, miconazole)  7 days
    Oral azole are not given due  to increased risk of miscarriage  and birth defects.

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    Categories
    Pharmacology

    Treatment for a Pregnant Woman at High Risk of GBS Infections During Delivery.

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    Disclaimer:

    This is not a prescription. Using medicines without the guidance of a licensed provider  can be lethal.

    1. IV Penicillin G or ampicillin  during labor, until delivery.
    2. IV cefazolin if patient is,  allergic to Penicillin and  is at low risk of anaphylaxis.
    3. IV clindamycin or erythromycin  is acceptable in high risk of  anaphylaxis.
    4. IV vancomycin if susceptibility  to clindamycin and erythromycir is not established.

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    Categories
    Pharmacology

    Treatment for Depressions and Anxiety

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    Disclaimer:

    This is not a prescription. Using medicines without the guidance of a licensed provider  can be lethal.

    SSRls are the first line  Citalopram, escitalopram,  flouxetine, fluvoxamine, paraoxetine, sertralifie

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    Categories
    Pharmacology

    Cystitis in Pregnancy

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    Disclaimer:

    This is not a prescription. Using medicines without the guidance of a licensed provider  can be lethal.

    Avoid trimethoprim and quinolones during pregnancy

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    Co-amoxiclav

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    250/125 mg

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    3 times daily

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    Cefalexin

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    250 mg

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    4 times daily

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    Amoxicillin

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    250 mg

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    3 times daily

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    Categories
    Pharmacology

    Treatment of Pyelonephritis

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    Disclaimer:

    This is not a prescription. Using medicines without the guidance of a licensed provider  can be lethal.

    1-2 days of intravenous (IV) fluoroquinolones, aminoglycosides, or 3rd gen cephalosporins, followed by outpatient oral antibiotics.Severe or complicated cases  may require 14 to 21  days of IV antibiotics ;Early mild cases in reliable patients may be amenable to oral antibiotics.

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    Categories
    Pharmacology

    NSAIDs

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    Disclaimer:

    This is not a prescription. Using medicines without the guidance of a licensed provider  can be lethal.

     

    NSAIDs can induce many  types of kidney injury:

    Hemodynamicaly triggered  acute kidney injury (AKI) Electrolyte & acid-base issues Acute interstitial nephritis (AIN)

    (May be accompanied by
    the nephrotic syndrome)
    Papillary necrosis

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    Categories
    Pharmacology

    Chlamydia First Line Treatment

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    Disclaimer:

    This is not a prescription. Using medicines without the guidance of a licensed provider  can be lethal.

     

    CDC recommends either  one of these as the first line

    Tetracyclin (doxycycline)  100 mg twice daily x 7 days

    MaciOlide (azithromycin)  1 g single dose

    Remember C. Trachomatis  is a reportable STD in the US and Canada.

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    Categories
    Pharmacology

    Treatment of Strep Viridan Subacute Infective Endocarditis

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    Disclaimer:

    This is not a prescription. Using medicines without the guidance of a licensed provider  can be lethal.

    For a patient not allergic to penicillin

    1. IV benzyl penicillin  6 times daily 4 weeks
    2. IV gentamicin 3 times daily 2-4  weeks based on MIC

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    Categories
    Pharmacology Renal Pharmacology Renal System

    EXPLORING DIURETICS

    Diuretics forms one of the base pillars in treating hypertension and edema. These groups of drugs increases  rate of urine flow. Based on their mechanism of action their efficacy varies. Before moving into diuretics I would recommend to revise renal physiology which will make it easier to get deeper and clear concept of mechanism of diuretics. In this section I will not go into details of each and every diuretics, I would rather try to provide concept and differentiating feature based on mechanism of action and adverse effects.

    ADVERSE EFFECTS OF DIURETICS

    Efficacy

    Class of diuretics Example
    Carbonic Anhydrase Inhibitors (CAI) WEAK Acetazolamide
    Osmotic diuretics WEAK Mannitol
    Loop diuretics HIGH Furosemide
    Thiazide MEDIUM Hydrochlorothiazide
    Potassium sparring diuretics WEAK

    Amiloride (Sodium channel inhibitors)

    Spironolactone (Aldosterone receptor antagonist)

    Lets revise different section of nephron, (see the figure)

    1. Bowman’s capsule
    2. Proximal Convoluted Tubule (PCT)
    3. Loop of Henle (LOH), Thin descending loop
    4. Loop of Henle (LOH), Thin ascending loop
    5. Loop of Henle (LOH), Thick ascending loop
    6. Distal Convoluted Tubule (DCT)
    7. Cortical collecting tubule
    8. Medullary collecting tubule

    Different drugs mention above have different sites for action, they reason why their efficacy and side effects varies from each other. Action of drugs:

    Site of nephron Action of drugs
    1.      Bowman’s capsule
    2.      Proximal Convoluted Tubule (PCT) Carbonic Anhydrase Inhibitors
    3.      Loop of Henle (LOH), Thin descending loop Osmotic diuretics acts here (Osmotic Diuretics also acts in Proximal tubule)
    4.      Loop of Henle (LOH), Thin ascending loop
    5.      Loop of Henle (LOH), Thick ascending loop Loop diuretics
    6.      Distal Convoluted Tubule (DCT) Thiazides diuretics
    7.      Cortical collecting tubule

     

    Potassium sparing diuretics

    Potassium sparing diuretics also acts in late distal tubule.

    8.      Medullary collecting tubule

    MECHANISM OF ACTION

    As the normal mechanism of each section of the varies, so drugs acting on different section of nephron have different side effects, though their ultimate goal is to increase the rate of flow of urine.

    Mechanism of action of these groups of drugs

    1. Carbonic Anhydrase Inhibitors

    Carbonic Anhydrase Inhibitors

    Acts in Proximal Convoluted Tubules

    Inhibits carbonic Anhydrase

    Increases excretion of NaHCO3

    Increased rate of flow of urine

    1. Osmotic diuretics

    Osmotic diuretics

    Acts in proximal tubules and thin descending loop of Henle, thin ascending loop of Henle

    Due to osmotic effect, increases excretion of water

    Increased rate of flow of urine

    1. Loop diuretics

    Loop diuretics

    Acts in thick ascending loop of Henle

    Blocks sodium, potassium, chloride co transporter

    Increases sodium, potassium, chloride excretion

    Increased rate of flow of urine

    1. Thiazides

    Thiazides

    Acts in Distal Convoluted Tubules (DCT)

    Blocks sodium chloride transporter

    Increased excretion of NaCI

    Increased rate of flow of urine

    1. Potassium sparing diuretics (Acts in late distal tubule and collecting tubules)

    They can be of two types:

    1. Sodium channel blockers
    2. Aldosterone receptor antagonists

               Sodium channel blockers

           Blocks sodium channel

                 Increases sodium excretion and increases potassium retention

    Increased rate of flow of urine

          Aldosterone receptor antagonists

    Acts as antagonist in aldosterone receptor 

    Promotes sodium and chloride excretion without concomitant potassium loss

    Increased rate of flow of urine

    ADVERSE EFFECTS of these groups of drugs

    Side effects of Carbonic Anhydrase Inhibitors

    Hyper Hypo
    Apnea Potassium
    Metabolic acidosis

    Ataxia

    Tinnitus

    Side effects of Osmotic Diuretics

      Hypo
    Natremia

    Volemia

    Fluid and electrolytes imbalance

    Acidosis

    Dehydration

    Urinary retention

    Side effects of Loop Diuretics  

    Hyper Hypo
    Urea

    Glucose

    Tension

    Volemia

    Magnesium

    Potassium

    Sodium

    Calcium

    Metabolic Alkalosis

    Arrhythmias

    Ototoxicity

    Side effects of Thiazide diuretics

    Hyper Hypo
    Urea

    Glucose

    Calcium

    Tension

    Volemia

    Potassium

    Sodium

    Magnesium

    Metabolic Alkalosis

    Azotemia

    Side effects of Potassium sparing diuretics

    Hyper Hypo
    Potassium Sodium
    Metabolic Acidosis

    Gynecomastia

    Impotence

    ADVERSE EFFECTS OF DIURETICS

    Note:

    Hyper Sodium: Hypernatremia

    Hyper Potassium: Hyperkalemia

    There are many more side effects, and more detailed mechanism of action, but it is important to have base concept before moving details of each drugs.

    HAPPY READING.

    If you find it fruitful, do not hesitate to share the information in your friends circle.

     

     

    Dr Bivek Singh

    Academic coordinator (MBBS)

    Author “A journey into the human body”

    Author “Pharmacology Simplified”

    Board of Directors (Medical Outreach Nepal, USA)

    biveksingh@hotmail.com

    www.facebook.com/drbiveksingh