Antiemetics

This video shows Classification, Pharmacological actions, Mechanism of Action, Pharmacokinetics, Uses and Side effects of all Antiemetics.

Magnesium sulfate as the drug of choice for controlling eclamptic seizures

The drug of choice for controlling eclamptic seizures is

• A) hydralazine
• B) phenobarbital
• C) phenytoin
• D) diazepam
• E) magnesium sulfate

Answer and Discussion

The answer is E. 

In the United States, magnesium sulfate is considered the drug of choice for controlling eclamptic seizures. Fewer intubations are required in the neonates of eclamptic women who are treated with magnesium sulfate. In addition, fewer newborns require placement in neonatal intensive care units. In the treatment of eclampsia and preeclampsia, magnesium sulfate is often given according to established protocols. If serum magnesium levels exceed 10 mEq/L (5 mmol/L), respiratory depression can occur. This problem may be counteracted by the rapid intravenous infusion of 10% calcium gluconate. Magnesium sulfate should be used with caution in patients with impaired renal or cardiac status. It should not be used in patients with myasthenia gravis.

Simple Terms to learn about effect of drugs on CNS

- Sedation : Reduction of anxiety
- Addiction : The state of response to a drug whereby the drug taker feels compelled to use the drug and suffers anxiety when separated from it
- Anesthesia : Loss of consciousness associated with absence of response to pain
- Anxiolytic : A drug that reduces anxiety, a sedative
- Dependence : The state of response to a drug whereby removal of the drug evokes unpleasant, possibly life-threatening symptoms, often the opposite of the drug's effects
- Hypnosis : Induction of sleep
- REM : sleep Phase of sleep associated with rapid eye movements; most dreaming takes place during REM sleep
- Tolerance : Reduction in drug effect requiring an increase in dosage to maintain the same response

Azithromycin is the treatment of choice for Bordetella pertussis

Which of the following medications is considered the treatment of choice for Bordetella pertussis infection?

• A) Penicillin
• B) Ciprofloxacin
• C) Azithromycin
• D) Tetracycline
• E) Cefuroxime

Answer and Discussion

Recent epidemiologic studies have shown that the incidence and prevalence of Bordetella pertussis infection in adults are much greater than previously reported. In studies of adults with chronic cough, 20% to 25% were found to have serologic evidence of recent B. pertussis infection. However, pertussis is rarely considered in adults because the signs and symptoms are nonspecific.

Apart from a prolonged cough, there are no specific symptoms suggestive of pertussis in older individuals who have been immunized. With this in mind, pertussis should be considered in the differential diagnosis of persistent cough in previously immunized children and adults.

-Administration of erythromycin or other macrolide (azithromycin or clarithromycin) may be a consideration in patients presenting with persistent cough. Prophylaxis of exposed persons before culture or serologic results are available would be another consideration. Early treatment with a macrolide should limit the spread of infection to persons whose immunity has waned or in unimmunized children. The acellular vaccine may allow booster immunization, which can be a method of preventing B. pertussis infection after immunity from the pertussis vaccination has waned.
So;The answer is C.

Bleomycin-Induced Flagellate Hyperpigmentation

A 39-year-old woman with a long-standing vascular malformation of the posterior tongue underwent intralesional sclerotherapy with a single dose of bleomycin. Within 1 week after treatment, painless, nonpruritic, flagellate hyperpigmentation developed on her trunk. She had no alopecia and no changes in the appearance of nails or mucosa. She reported having no dyspnea or pulmonary symptoms.
Bleomycin is a glycopeptide antibiotic commonly used for chemical pleurodesis, the treatment of cutaneous warts, and the treatment of a variety of cancers. The rate of flagellate hyperpigmentation in patients who are treated with bleomycin may be as high as 20%. Most tissues contain a cysteine proteinase capable of hydrolyzing and inactivating bleomycin. The reduced concentration of bleomycin hydrolase in the skin and lung, as compared with other tissues, may explain the medication's adverse reaction profile.

The patient was counseled that the flagellate hyperpigmentation usually fades over a period of several months after the cessation of the medication. During the past year, the hyperpigmentation in this patient has faded but not yet resolved.

Beta2 Adrenergic Receptor Mnemonic

Beta2 Adrenergic Autonomic Receptor of the Sympathetic Nervous System presented in a pictorial mnemonic format . Key Point: Beta2 expands. For Medical learning.

Angioedema caused by angiotensin-converting enzyme (ACE) inhibitor

Swollen tongue caused by angiotensin-converting enzyme (ACE) inhibitor-associated

angioedema.

Diagnosis:

Angioedema is a clinical diagnosis. If the patient presents with the characteristic swelling of the
mouth, lips, tongue, or pharynx and is also taking an ACE inhibitor, the diagnosis should be highly suspected.

Clinical Complication:
Airway compromise secondary to swelling of the tongue, uvula, soft palate, and larynx is a common and potentially life-threatening complication of ACE inhibitor-associated angioedema.

Management : Patients with impending airway compromise require the immediate establishment of a definitive airway. Those with less severe findings need early medical management with intravenous (IV) antihistamines, steroids, and subcutaneous epinephrine. After discontinuation of the ACE inhibitor and administration of the appropriate medications, most cases of ACE inhibitor-induced angioedema resolve within 12 to 48 hours.2 However, this angioedema can proceed rapidly to life-threatening airway closure and must be treated as a serious emergency.

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Side effects of Prostaglandin E1 on neonates

Prostaglandin E1 used in:
 Maintain patency or reopen ductus arteriosus in case of
1. Cyanotic Congenital Heart Disease

• Transposition of the Great Vessels
• Tricuspid atresia

2. Aortic Coarctation

# Side effects are common and potentially lethal

1. Flushing
2. peripheral edema
3. Hypotension
4. Apnea
5. Hyperpyrexia
6. Jitteriness
7. Diarrhea
8. Hypoglycemia
9. Hypocalcemia
10. Renal Failure
11. Rhythm disturbance
12. Coagulopathies

Note that : Start with "x" mg of Prostaglandin E1( Where "x" = 0.3 x WeightKg )
-Add enough D5W or NS to Prostaglandin for 50 ml total
At this dilution: Infusion rate of 0.5 ml/min provides 0.05 ug/kg