Pharm 2-2

• -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;

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

• EFFECTS; INITALLY DECREASE EXTRACELL FLUID VOL THUS LO BP AND CO
• THEN IT IS THOUGHT THAT WITH LO NA STORES IT DIM THE SNS

• 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)

• 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

• 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)

• 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

• MANNITOL AND UREA
• RESIST META
• UP OSMOTIC PRESSURE AND PULL FLUID INTO THE INTRAVASCULAR SPACE
• PT WITH CHF MAY NOT TOL INCREASE IN VOL

• 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

• SMALL SIZE VS MANNITOL AND IS FILTER IN KIDNEY
• CROSSES BBB AND CAUSES REBOUND INTRACRNAIL PRESSURE
• SE VENOUS THROMBOSIS, AND TISSUE NECROSIS

• 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

• 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)

• 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

• 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

• 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

• INCREASE LEVEL DT S SHOCK, ALLERIGIC REACTIONS, CORCINOID SYNDROME
• LOW AMOUNTS=HTN
• TOO MUCH = REACTION

• 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

• 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

• HT1 FOR MIGRAINES AND CLUTTERS HA
• SQ 6 MG WITH T.5 2 HOURS MAY REPEAT
• SE CORONARY VASOCON LEAD TO MI

• 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)

• SEROTININ ANTOGONIST
• LYSERIC ACID (LSD WITH NO CNS EFFECTS)
• MIGRAINES MALABSORBTION AND DIARRHEA
• SE RETROPERITONEAL, PLEUROPULMONARY, CORONARY, ENDOCARDIAL FIBROSIS

• LIKE H1 BLOCK BUT BLOCK SEROTININ AND HISTAMINE
• TREAT SEASONAL ALLERIES, APPEITIE STIMULATION, SCHIZOPHRENIA, SPINAL CORD DAMAGE, HA, NELSON SYNDROME

• 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

• 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,

• 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

• 100-600MG 4-6HR
• START AT 200MG
• MAX 3-4 GRAMS

• 100MG Q5 MIN
• MAX 5MG/KG

• 2MG/KG BOLUS
• 1-5 MG/KG/MIN

• 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

• 80 MG BID
• MAX IS 480-640MG OVER BID OR TID

• PRE GIVE 2GR MAG AND 40 OF K
• 1 MG >60KG
• 0.01 MG<60KG MAY REPEAT IN 10 MINS

6 MG TO 12MG TO 12 MG WITH 30 MG MAX