Tales from the hospital ward

Budesonide (Pulmicort) class:    Inhaled cortico Steroid;  also available as a  topical nasal steroid decongestant   action: not known , anti-inflammatory Indications :  prevention and treatment of asthma, adjunct to those not controlled by traditional bronchodilators, NOT FOR ACUTE ATTACKS,  allergic rhinitis, relief of inflammation after removal of nasal polyps. Actions : Decereases inflammation in airway. promotes beta 2 adrenergic receptor activity. Contraindicated: acute infections. (due to blocking of inflammatory response). Systemic effects minimal. Care during pregnancy. Adverse: Sore throat. local burning irritation, stinging, headache, dry mucosa, hoarseness, coughing,dry mouth and fungal infections are common side effects. REBOUND CONGESTION. Drug – drug: not found Care/ Teaching:   take up to 1 week to cause changes, no effects after 3 weeks discontinue. not absorbed systemically if inhaled corr...

Ipratropium (Atrovent) class : anticholinergic Note: nasal spray, and inhaler Indications : maintenance of bronchospasm associated with COPD, treatment of allergic rhinitis as nasal spray. Actions : antagonizes the action of acetylcholine. Blocks vagally mediated reflexes. Dries up secretions caused by stimulation of PNS. Action is SLOW.  This is more of a preventer. Adverse : Nervousness, dizziness, headache, nausea, GI distress, cough, palpitations. Drug – drug: other anticholinergics. peanut allergies Contraindications . Any condition aggravated by atropine like effects. Eg narrow angle glaucoma, bladder neck obstruction or prostatic hypertrophy, conditions aggravated by dry mouth and throat. The presence of known allergy to drug or soy products o r peanuts ( the vehicle used to make ipratropium int an aerosol contains a protein associated with peanut allergies) Drug : drug: other anticholinergics eg Atropine           ...

Diphenhydramine (Benedryl) class : Antihistamine ( expectorant) book p 829 says benedryl is guaifenesin Actions : enhances output of respiratory tract fluids, reduces adhesiveness and surface tension of these fluids.-> more productive cough-> less coughing. Competitively blocks histamine at H1 receptors sites. Has atropine like antipruritic and sedative effects Indications : symptomatic relief of respiratory conditions for a dry nonproductive cough in the presence of mucus in the respiratory tract. Adverse : drowsiness and sedation. Dryness of respiratory and GI memebranes.Nausea, vomiting headache, dizziness, rash Drug – drug: moai, interacts fexofenadine, ketoconazole or erythromycin Contraindications : diabetics (syrup of sugar) Care/ Teaching : Administer on empty stomach, 1 hour before or 2 hours after meal, to increase absorption. May be given with meals if gi upset. lozenges to relieve dry mouth and GI upset., safety for falls, avoid alchohol,-> serious s...

Glucagon Classification : Hypoglycaemic agent  Indications: hypoglycaemia, if unconscious. Action : raises glucose levels, stimulates breakdown of glycogen – Increase the blood glucose levels by decreasing insulin release and accelerating the breakdown of glycogen in the liver to release glucose Gluconeogenesis   ( GNG ) is a   metabolic pathway   that results in the generation of   glucose   from non- carbohydrate   carbon substrates such as pyruvate ,   lactate ,   glycerol , and   glucogenic amino acids   glycogenolysis : the degradation of   glycogen to glucose . •Indications –Treatment of hypoglycaemia •Pharmacokinetics –Rapidly absorbed and distributed throughout the body –Excreted in the urine Adverse reactions : GI upset – Vascular effects Contraindications: Known allergy –Pregnancy and lactation Care considerations: Caution: Hepatic dysfunction or card...

Metformin Classifications : Bigauanide Indications: Adjunct to diet and exercise for type II DM older than 10 yrs Extended release form for older than 17 yrs Action : Decreases production of glucose (liver) –Increases uptake of glucose (cellular) –Increase production of insulin (pancreas) Approved for use in children Adverse reactions: – Hypoglycaemia –GI distress - anorexia, nausea, vomiting, heartburn, diarrhoea –Allergic skin reactions Contraindications: diabetes complicated by fever, trauma, ketoacidosis, renal or hepatic dysfunction. Care considerations: Monitor nutritional status. Administer in appropriate relationship to meals to ensure therapeutic effectiveness. Monitor activity levels(stress due to infection, trauma etc), adjust dose accordingly. Monitor blood glucose levels. Drug-drug: Drugs that acidifies the urine –Beta blockers –Alcohol 

Glibenclamide (Sufonylurea) Classifications : Sufonylurea- works only if pancreas has functioning beta cells. Adjunct to diet and exercise to lower blood glucose levels in type 2 DM Action:  Stimulate insulin release from the beta cells in the pancreas – They improve binding to insulin receptors -           Metabolized in liver and excreted in bile and urine Safer for those with renal disease. Adverse reactions : –Hypoglycaemia –GI distress : anorexia, nausea, vomiting, heartburn, diarrhoea –Allergic skin reactions   Contraindications : hypersensitivity, dka, diabetes complicated by fever, trauma, surgery ,renal or hepatic disease etc. Not for type 1 diabetics. Not for pregnancy. Care considerations : Learn to recognize signs of hypoglycaemia and hyperglycaemia to effectively manage condition. Drug-drug : – Drugs that acidifies the urine –Beta blockers –Alcohol 

Insulin Classifications : exogenous Insulin Action: Is a hormone that promotes the storage of the body’s fuels 1.     Simulates the synthesis of glycogen from glucose (   glyconeogenesis ) 2.     Reacts with specific receptor sites to allow glucose into the cell –      Replaces endogenous insulin - Suppresses lipolysis – Glyco -neo-genesis:   The formation of glycogen from noncarbohydrates, such as protein or fat, by conversion of the latter to d-glucose.(medi lexicon) – Conversion of lipids into fat Various insulins available are processed within the body like endogenous insulin – Peak, onset and duration vary based on preparation Indications – Treatment of type 1 diabetes mellitus (IDDM) – Treatment of type 2 diabetes mellitus in people whose diabetes cannot be controlled by diet or other agents - treatment of type 2 diabetics who are stressed - managment of DKA, hyperkalaemia, and marked...

Atorvastatin (Lipitor) Class: HMG-CoA reductase inhibitor.(includes Crestor and Zocor). •Actions – Inhibits HMG-CoA, decreases serum cholesterol levels , LDLs, and triglycerides, increases HDL levels. Less cholesterol produced in the liver. • Indications – Adjunct to diet in the treatment of elevated cholesterol, triglycerides, and LDL; – increase HDL-C in individuals with primary hypercholesterolaemia; – treat familial hypercholesterolaemia and two+ risk factors for CAD •Adverse Effects – GI symptoms: flatulence, abdominal pain, cramps, nausea, vomiting and constipation – CNS: Headache, dizziness, blurred vision, insomnia, fatigue –Liver failure –Rhabdomyolosis – muscle wasting • Drug-to-Drug Interactions – Erythromycin, cyclosporin, gemfibrozil, niacin –Digoxin or warfarin –Oestrogen – Grapefruit juice Contraindications : allergy. Active liver disease. Care considerations : attempt lifestyle changes, avoid dehydration. Hyperlipid...

Glyceryl trinitrate (GTN)(Anginine, Nitrodur, Nitrolingual) Class : antianginal agent                                                         Actions: The nitrates relax and dilate veins, arteries and capillaries . Lowers systemic blood pressure. Cad causes stiffening, may not get response in coronary arteries. Blood flow through healthy vessels is increased. Main effect v BP. Relaxation of the vessels decreases afterload. Decrease workload of heart. •Actions – Act directly on smooth muscle to cause relaxation (vasodilation) and depress muscle tone •Indications – Prevention and treatment of attacks of angina pectoris (stable and unstable) •Pharmacokinetics –Very rapidly absorbed – Meta...

Digoxin Class : Cardiac glycoside Indications: prevention and treatment of angina pectoris. Requires a loading dose . *derived from foxglove ·          Increases intracellular  ca++, and allows more ca++ to enter cell during depolarization ·          Increased myocardial contraction(inotropic effect) ·          ^ CO & ^ renal perfusion(stops angio-renin)-> ^ Urine output (diuretic) &  v BVol ·          V HR due to slower repolarization( a –ve chronotropic effect) ·          Decreased conduction velocity through AV node Adverse:   Headache, weakness, drowsiness, and vision changes –GI upset and anorexia – Arrhythmia development Contraindications: -           tachycardia or fibrillati...

Clopidrogel hydrogen sulfate/ Iscover Plax Plavix                                 preg risk B Indications: to reduce atherosclerotic events where there is MI, CVA or peripheral arterial disease.   Action: ANTIPLATELET inhibits platelet aggregation, by inhibition of binding of ADP to its platelet receptor.Irreversible modification of platelet, LASTS FOR LIFETIME OF PLATELET-lasts 5days, indicated for those intolerant to aspirin. Adverse : CNS: headache, dizziness, fatigue, depression, pain ENT: rhinitis, epistaxis GI: haemorrhage, abdo pain, dyspepsia, gastritis, constipation, diarrhea, ulcers GU: UTI Haematologic: purpura Musculoskeletal: arthralgia Respiratory: bronchitis, coughing, dyspnea, upper respiratory tract infection Skin : rash, pruritus Flu-like syndrome Contraindications ...

Heparin sodium                                                       preg risk C Indications/actions : prevention of deep vein thrombosis, MI, pulmonary embolism. Accelerates formation of antithrombin III complex, and deactivates thrombin, preventing conversion of fibrinogen to fibrin. Interfere with the normal cascade of events involved in the clotting process. Parenteral Adverse: Haematologic: haemorrhage(excess dose), ^clotting time,thrombocytopenia, white clot syndrome Skin: cutaneous or SC necrosis GI upset Other: irritation, mild pain, haematoma, ulceration, hypersensitivity reactions(chills, fever pururitus, rhinitis, urticaria) anaphylactoid reactions Drug-drug: oral anticoagulants. Increas...

Enoxaparin /Clexane                     preg risk C Indications/actions : Prevention of pulmonary embolism and deep vein thrombosis(hip or knee surgery)/low molecular weight heparin. Interfere with the normal cascade of events involved in the clotting process. Surgery, injury, prolonged bed rest, prescribed by weight. Admin- SC . The bubble in the prefilled syringe, ensures that the full dose and the bubble stays in the syringe. Adverse: CNS: confusion, neurological injury when used with spinal or epidural puncture, fever, pain CV: oedema, peripheral oedema, CV toxicity(chest pain, dizziness,irregular heartbeat) GI: nausea Haematologic: hypochromic anaemia, thrombocytopenia, haemorrhage , ecchymoses; bleeding complicaitons. Skin: rash hives Drug-drug : anticoagulants, drugs that alter platelet function(salycilates) Contraindications: hypersensitivity, major bleeding ...

Tenecteplase(Metalyse) Indications :Thrombolytic  -clot buster (ghost buster)                                                                                      Thrombolytic. Reduction of mortality - Acute MI –       Pulmonary emboli –       Ischemic stroke only available as an injectable. Monitored closely by attending physician. Action: a human tissue plasminogen activator that binds to fibrin. Adverse : uncontrollable bleeding, cardiac arrhythmias, hypersensitivity Drug-drug : anticoagulants, drugs that alter platelet function(salycilates) Contraindications : hypersensitivity, many others, monitored by physician Care considerations : arrange to administer tene...

Warfarin                                   preg risk D I ndications/Actions : DVT,pulmonary embolism, MI, rheumatic heart disease. Interfere with the normal cascade of events involved in the clotting process. Inhibits vitamin K dependent activation of clotting factors. Oral tabs Adverse : Ha ematologic: bleeding, GI upset, Hepatic dysfunction, Headache, fever Other: alopecia, dermatitis, bone marrow suppression, prolonged and painful erection Don’t need to learn drug to drug as there are too many, but any other anticoagulant- lecture Drug- food : avoid foods containing vitamin K, however maintain vit K levels by eating consistent amount of leafy green veg. Avoid alcohol. Contraindications:hyp ersentivity, active bleeding, hepatic disease, renal disease, pregnancy, haemorrhagic stroke within past 6 months, thr...

Atenolol / Anselol, Noten, Tenormin, Tensig  preg risk C Classifications : antihypertensive Action : A beta blocker Adverse reactions:        bradycardia       fatigue, lethargy, vertigo, fever, drowsiness, dizziness     bradycardia, hypotension, HF, intermittent claudication       nausea, diarrhoea       leg pain       dyspnoea, bronchospasm      rash Contraindications: Drug-drug: antihypertensives, use together cautiously;cardiac glycosides, dilitazem, verapamil- excessive bradycardia and increase depressant effect on myocardium; insulin, oral diabetics- altered dosage reauirements with previously stabilised diabetes. Care considerations: ·          Use cautiously in individuals at risk of HF, have bronchospastic disease, diabetes and hyperthyroidism. ·          Che...