PHARMACOLOGY – Simplified, not Mystified. “ The arrival of a good clown exercises a more beneficial influence on the health of a town than 20 asses laden with drugs.” Dr. Thomas Sydenham (1624-1689). The Numbers…. 30 years ago there were 900 drugs to choose from in the PDR
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1) cimetidine (Tagamet)—for heartburn
2) acetaminophen (Tylenol) is in over 300 over-the-counter products (Tylenol)—inadvertent overdoses (narrow therapeutic index—toxic dose is not much higher than therapeutic dose)
….as well as numerous prescription analgesics… Fioricet, Lorcet, Percocet, Propacet, Roxicet, Ultracet (limit “cets” to 325/mg per tab to reduce toxicity)
Ibuprofen (Advil, Motrin, etc) PO—200 mg = to 650 of ASA; 400 mg superior w/ longer duration of ASA; 400 mg comparable to acetaminophen/codeine combination without the constipation w/ codeine; interferes with ASA cardiovascular prophylaxis; take 2 hours after aspirin
IV ibuprofen is Caldolor (400-800 mg q 6h)
Flubiprofen (Ansaid)—osteoarthritis, RA
Medical Letter, April 2010 (volume 8, issue 92)
As a general rule, classes of drugs have the same generic “last” name
Enzyme (ACE) (primarily in the pulmonary circulation)
She triggers release of “AL”—aldosterone (from the adrenal cortex to save sodium & H2O in the kidney)
She increases inflammation in the arteries
She increases tissue resistance to insulin
She’s a potent growth factor and “remodels tissues”…What does “angie II” do?
(as many as 70% of hypertensive patients in U.S. may have elevated RAA systems (renin-angiotensin-aldosterone)
Is “remodeling” a good word? Hmmmmm….
( ↑ vasodilation by
( ↑ prostaglandins)
( ↑ vasoconstriction via
( ↑ angiotensin II)
PRILS inhibit ATII/vasodilate the efferent arteriole
(American Journal of Kidney Diseases December 2007)
atenolol (Tenormin), metoprolol (Lopressor), betaxolol (Kerlone); bisoprolol (Zebeta), nebivolol (Bystolic)@ doses <10 mg)
B2—skeletal muscle (tremor), bronchioles of the lungs (bronchodilation), large arteries of the legs (vasodilation), piloerection (hairs stand up on back of neck and arms)—NONSELECTIVE BETA BLOCKERS
Why don’t we pick just any old beta blocker? Because the non-cardioselective beta blockers block both the B1 AND B2 receptors and can wreak havoc in certain patient populations
propranolol (Inderal), nadolol (Corgard), timolol (Blocadren), carvedilol (Coreg)
atenolol (Tenormin), nadolol (Corgard), labetalol (Trandate), nebivolol (Bystolic)
Atrial fibrillation, Hypertension, Angina, Vasospasm
Less constipation than verapamil
(American Journal of Clinical Nutrition May 2006)
pulmonary toxicity, hypotension, and cardiac arrhythmias, (TSH). Avoid using Amiodarone in patients who may not understand the toxic potential of this interaction.
Who are they?
1) get dental exam before starting drugs
2) good dental hygiene reduces risk
3) might not help to do a drug holiday as these drugs stay in the bones for years (esp. Fosamax)
Who are they?
H+, Intrinsic Factor-B12
PPIs work here
H2 blockers work here
Tx must be started within 48-72 hours after the first signs of a rash appear.
“The FDA this week approved the first-ever transdermal patch for the treatment of depression. Simply remove the backing and press the patch firmly over your mother’s mouth.” Tina Fey, on Saturday Night Live (March 2006)
*uncomplicated UTI if resistance to TMP/SMX is ≥20%