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THIAZIDE DIURETICS
- -THIAZIDES, -ONE
- JNC7 INTIAL TX FOR ESSENTIAL HTN OR IN COMB WITH OTHER HTN MED
- PO IV(MOBILIZE EDEMA)
- TX HTN, DI, HYPERCALCEMIA
- MED, CHLOROTHIAZIDES, CHLORTHALIDONE, HYDROCHLOROTHIAZIDE, HYDRODIURIL, INDAPMIDE, METHYCLOTHIAZIDE, METOLAZONE
- MOA; STOP REABORBATION OF NA AND CHLORIDE IN LOOP ASCEDING PART OF HENLE AND PROX AND DISTAL RENAL TUBE
- DOES NOT WORK AS WELL WITH POOR GFR
- EFFECTS;
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THIAZIDE MED
CHLOROTHIAZIDES, CHLORTHALIDONE, HYDROCHLOROTHIAZIDE, HYDRODIURIL, INDAPMIDE, METHYCLOTHIAZIDE, METOLAZONE
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THIAZIDE MEC OF ACTION AND EFFECTS
MOA; STOP REABORBATION OF NA AND CHLORIDE IN LOOP ASCEDING PART OF HENLE AND PROX AND DISTAL RENAL TUBE
- EFFECTS; INITALLY DECREASE EXTRACELL FLUID VOL THUS LO BP AND CO
- THEN IT IS THOUGHT THAT WITH LO NA STORES IT DIM THE SNS
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THIAZIDES SE
- SE- LO K, CL, GLUCOSE, AND MAG META ALKALOSIS
- LO K= CARDIO ARRHY, SKELETAL MUSCLE WEAKNESS, DIG TOX, ILEUS,
- LO INTRAVAS VOL, UP BUN AND HCT, UP URIC ACID (GOUT)
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LOOP DIURETICS WITH MEDS MOA
- STOP REABSORPTION OF NA AND CL IN ASCENDING LOOP OF HENLE
- RESPONDS WELL TO GOOD OR BAD GFR
MEDS: BUMTANIDE, ETHACRYNIC ACID (NO SULFA BUT POTENT), FURSEMIDE, TORSEMIDE
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LOOP DIURETICS
- 1. MOBLIZATION OF FLUID
- LASIX 0.1-1 MG/KG TO LO EDEMA DT LIVE, CARDIO OR RENAL FAILURE
- PERI VASODIL PRIOR TO DIURESIS(REASON WHY WORKS FOR ON PUL EDEMA)
- 2. TX UP ICP
- LO CSF, AND IMPROVING CELLULAR WATER TRANSPORT
- WORK WELL WITH MANNITOL (BETTER TOGETHER THAN ALONE BUT UP DEHYDRATION AND ELECTROLYTE IMBALANCE)
- 3. DIFFERENTIAL DIA OF ACUTE OLIGURA (SEE IF DRY)
- SMALL DOSE(0.1 MG/KG) BUT NOW MORE COMMON FOR BOLUS CHALLANGE
- 4. ACUTE RENAL FAILURE
- CONTROVERSIAL, ATTEMPTS RO CONVERT OLIGURIC TO NONOLIGURIC RENAL FAILURE (NO REAL PROVINE RESULTS)
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LOOP SE
- LO K, CL
- UP SUGAR, BICARB, DIG TOX, NEPHROTOX, SENSITIVITY TO SULFONAMIDES (X EA)
- IF PUSHED TO FAST DAMAGE TO CN8 (DEAFNESS)
- LO CLEAREANCE TO LITHUM
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OSMOTIC DIURETICS
- MANNITOL AND UREA
- RESIST META
- UP OSMOTIC PRESSURE AND PULL FLUID INTO THE INTRAVASCULAR SPACE
- PT WITH CHF MAY NOT TOL INCREASE IN VOL
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MANNITOL
- UP OSMOLARITY OF RENAL TUBELE AND PREVENTS WATER REABS
- WITH UP OSMOLARITY DRAW WATER INTRAVAS DECREASING BRAIN BULK AND UP RENAL BLOOD FLOW
- USE; PROPHLAXIS OF ARF- SURGERY, TRAUMA, AND BLOOD RX
- ICP- 0.25-1 G-KG WORKINGS IS 10-15 MIN AND LAST 2 HOURS (LOWERS CSF) DON'T GIVE IT BBB IS NOT INTACT (LESS EFFECTIVE OVER TIME)
- INTRACULAR PRESSURE-SHORT TERM REDUCTION
- ACUTE OLIGURA-0.25 G/KG IV IF HAVE REALLY BAD GFR OR RENAL TUBULAR FX THEN WILL NOT WORK
SE- PUL EDEMA, CHF, HYPOVOL, NEHTOTOXIN, EXCESSIVE LOSS OF H20 AND NA
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UREA
- SMALL SIZE VS MANNITOL AND IS FILTER IN KIDNEY
- CROSSES BBB AND CAUSES REBOUND INTRACRNAIL PRESSURE
- SE VENOUS THROMBOSIS, AND TISSUE NECROSIS
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POTASSUIM SPARRING DIURETICS
- MOA- ACT ON R TUBULAR TRANSPORT OF DISTAL CONVULTED TUBULE SPARRING K BUT OUT NA, CL AND BICARB (UP URINE pH)
- MEDS AMILORIDE, AND TRIAMTERENE
- USE; WITH THIAZIDE FOR HTN, MIX THE TWO TO HAVE NEUTRAL EFFECT ON K
- SE HYPER K
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ALDOSTERONE ANTAGONIST
- SPIRANOLACTONE (LOOKS LIKE ALDOSTERONE)
- BLOCKS ITS EFFECTS THOUGH OF ALDOSTERONE
- USE- ASCITIES DT CIRRHOSIS OF LIVEER, CHF, HTN WITH THIAZIDES
- SE- HYPER K, ANTIANDROGEN (ESTROGEN MORE PROMENANTE)
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EPLERONONE
- SELECTIVE ALDOSTERONE ANTAGONIST
- BLOCK AND BIND TO ALDOSTERONE
- LIKE SPIRONOLACTONE BUT IS NOT AS STRONG ANTIANDROGEN
- USE; CHF , LOWERS SEXUAL DYSFUNCTION, HTN
- SE- MI, ANGINA, HYPERK, ARRHYTHMIAS
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CARBONIC ANHYDRASE
- ACETAZOLAMIDE (SULFONAMINDE THAT BINDS TO CARBONIC ANHYDRASE)
- LOSS NA, AND BICARB (KEEP CL)
- TX META ALKALOSIS, INTRAOCULAR PRESSURE, LO SEIZURE ACTIVITY, AND ALTITUDE SICKNESS. LO CSF
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PLASMA KINIINS
- POLYPEPTIDES
- MOST POTENT ENDOGENOUS VASODILATORS
- INCREASE CAP PERMEABILITY=EDEMA, BURNING PAIN AT NERVE ENDINGS
- LAST >15 SEC,M 90% META VIA LUNG FIRST PASS,
- LEDS TO COUGH AND ANGIOEDEMA
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BRDAYKININS
- INCREASE LEVEL DT S SHOCK, ALLERIGIC REACTIONS, CORCINOID SYNDROME
- LOW AMOUNTS=HTN
- TOO MUCH = REACTION
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APROTININ
- BRADYKININ
- (OUT OF FAVOR)
- USED TO REDUCE BLOOD LOSS DURING RE-OPERATION(BYPASS OR GREAT VESSELS), ON COUMADIN OT TPA, JEVOHA WITNESS
- ACT (CELITE NOT KAOLIN) WILL BE ARTIFICALLY PROLONGED
- DOSE 1- 1 ML (1.4 MG)TEST DOSE, 2MILLION(280 MG)LOADING OVER 20-30 MIN THEN 500,000 (OR 70MG/HR)
- DOSE 2 IS HALF OF ALL ABOVE
- SE- RENAL DYFUNCTION, PHLEBITIS, DYSPNEA, BRONCHCON, MI STROKE, FEVER
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SEROTONIN
- ENDOGENOUS VASOACTIVE SUBSTANCE (AUTOCOID)
- NT OF N/V AND PAIN
- 90% IN GI TRACT
- IN CNS AND PLATELETS
- META BY MONOAMINE OXIDASE
- HT1=CEREBRAL VASOCON
- HT2= VASOCON OF CORONARY
- HT3= GI N/V
- HT4 METOCLOPROMIDE
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SUMATRIPTAN
- HT1 FOR MIGRAINES AND CLUTTERS HA
- SQ 6 MG WITH T.5 2 HOURS MAY REPEAT
- SE CORONARY VASOCON LEAD TO MI
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RIZATRIPTAN
- HT1D MIGRAINES
- 5-10 MG PO REPEAT 2HRS, MAD 30 MG IN 24 HRS, 1 MG MAX ON PROPRANONOL
- SE MAO INCREASE CONCENTRATION, INCREASE BP, CORONARY VASPSAMS (BUT LESS)
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METHYSERGIDE
- SEROTININ ANTOGONIST
- LYSERIC ACID (LSD WITH NO CNS EFFECTS)
- MIGRAINES MALABSORBTION AND DIARRHEA
- SE RETROPERITONEAL, PLEUROPULMONARY, CORONARY, ENDOCARDIAL FIBROSIS
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CYPROHEPTADINE
- LIKE H1 BLOCK BUT BLOCK SEROTININ AND HISTAMINE
- TREAT SEASONAL ALLERIES, APPEITIE STIMULATION, SCHIZOPHRENIA, SPINAL CORD DAMAGE, HA, NELSON SYNDROME
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ONDANSETRON
- 5HT3 ANTAGONIST
- 4 MG Q2-5 MIN FOR N/V PERIOP
- 0.15MG/KG PO OR 0.05-0.15MG/KG IV FOR KIDS
- NO SEDATION
- SE HA, DIARRHEA, UP LIVE ENZYMES
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DOLANSERTON
- HT3 ANTAGONIST
- PREVENT POST OP N/V BUT MUST GIVE 1 MIN A STOPPIN MEDS
- 12.5MG IV OR 100MG PO (2 HOURS A OR)
- KIDS
- 1.2 MG/KG WITH MAX 100 MG PO
- 0.35 MG/KG IV 15 MINS
- SE= PROLONG QT, LOK, LOMAG,
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PALONOSETRON HYDROCHOLORIDE
- GIVE TO PT IN CHEM IF ZOFRAN DIDN'T WORK
- INCREASE COST BUT LO SE AND LAST LONGER THAN ZOFRAN
- DOSE IV 0.25 MG OVER 30 MIN
- PO 0.5 MG 1 HOUR A START OF CHEMO
- 0.075 A INDUCTION IN OR
- SE= QT PROLONG, HA, LOBP, BRADYCARD, ANXIETY, DIZZINESS, FATIGUE, WEAKNESS, CONSTIPATION, AND DIARRHEA, UP LIVE ENZ
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QUINIDINE
- 100-600MG 4-6HR
- START AT 200MG
- MAX 3-4 GRAMS
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LIDIOCAINE
- 2MG/KG BOLUS
- 1-5 MG/KG/MIN
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AMINODARONE
- ACLS 300 MG THEN 150 MG
- GTT START 150 MG OVER 10 MIN THEN 1 MG/MIN FOR 8HRS TO 0.5 MG/MIN FOR 18HRS
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SOTALOL
- 80 MG BID
- MAX IS 480-640MG OVER BID OR TID
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IBUTILIDE
- PRE GIVE 2GR MAG AND 40 OF K
- 1 MG >60KG
- 0.01 MG<60KG MAY REPEAT IN 10 MINS
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ADENOSINE
6 MG TO 12MG TO 12 MG WITH 30 MG MAX
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