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Therapeutic dosing and monitoring of warfarin (Coumadin) Treatment with warfarin should be initiated with standard doses of 5–10 mg. The initial adjustment of the prothrombin time takes about 1 week, which usually results in a maintenance dosage of 5– 7 mg/d. The prothrombin time (PT) should be increased to a level representing a reduction of prothrombin activity to 25% of normal and maintained there for long-term therapy. When the activity is less than 20%, the warfarin dosage should be reduced or omitted until the activity rises above 20%. Inherited polymorphisms in 2CYP2C9 and VKORC1 have significant effects on warfarin dosing; however, algorithms incorporating genomic information to predict initial warfarin dosing were no better than standard clinical algorithms in two of three large randomized trials examining this issue. The recommended INR for prophylaxis and treatment of thrombotic disease is 2–3. Patients with some types of artificial heart valves (eg, tilting disk) or other medical conditions increasing thrombotic risk have a recommended range of 2.5–3.5. Types of anticoagulants- mechanisms of action and indications for use
- Vitamin K antagonists.
- Direct Oral Anticoagulants (DOACs)
- Low molecular weight heparins (LMWH) What is the mechanism of action for anticoagulants?
- Anticoagulants achieve their effect by suppressing the synthesis or function of various clotting factors that are normally present in the blood. Such drugs are often used to prevent the formation of blood clots (thrombi) in the veins or arteries or the enlargement of a clot that is circulating in the bloodstream. What are the indications for anticoagulants?
- Anticoagulation is an important component of the management strategy for several common medical conditions. It is indicated for the prevention of recurrent thrombosis in patients with venous thromboembolism (VTE) , which includes deep venous thrombosis and pulmonary embolism, and ischemic stroke. Understand Starling’s law The Frank-Starling Law states that the stroke volume of the left ventricle will increase as the left ventricular volume increases due to the myocyte stretch causing a more forceful systolic contraction. This assumes that other factors remain constant.
The Frank–Starling law of the h Starling's law and the Frank–Starling mechanism) represents the relationship between stroke volume and end diastolic volum he law states that the stroke volume of the heart increases in response to an increase in the volume of blood in the ventricles, before contraction (the end diastolic volume), when all other factors remain constant. [1]^ As a larger volume of blood flows into the ventricle, the blood stretches the cardiac muscle fibers, leading to an increase in the force of contraction. The Frank- Starling mechanism allows the cardiac output to be synchronized with the venous return, arterial blood supply and humoral length,[2] without depending upon external regulation to make alterations. The physiological importance of the mechanism lies mainly in maintaining left and right ventricular output equality. Medications which increase and decrease preload and afterload For heart failure, ACE inhibitors and ARBs reduce workload on the myocardium by reducing both preload and afterload. Preload: When some measure of left ventricular performance such as stroke volume or stroke work is plotted as a function of left ventricular filling pressure or end-diastolic fiber length, the resulting curve is termed the left ventricular function curve (Figure 13– 4 ). The ascending limb (<15 mm Hg filling pressure) represents the classic Frank-Starling relation described in physiology texts. Beyond approximately 15 mm Hg, there is a plateau of performance. Preloads greater than 20–25 mm Hg result in pulmonary congestion. As noted above, preload is usually increased in heart failure because eart (als o known as e.[1] T
- Class IV - Calcium-channel blockers.
- Miscellaneous - adenosine. - electrolyte supplement (magnesium and potassium salts) - digitalis compounds (cardiac glycosides) Diuretic (thiazide, loop, potassium-sparing) classes- mechanism of action, indications for use, side effects, contraindications, and be able to identify by name
Insulin classes, mechanisms of action, and be able to identify by name
Antidiabetic agent classes- mechanisms of action, indications for use, side effects, contraindications, and be able to identify by name What are the classes of antidiabetic drugs? Currently, six classes of oral antidiabetic drugs (OADs) are available: biguanides (e.g., metformin) , sulfonylureas (e.g., glimepiride), meglitinides (e.g., repaglinide), thiazolidinediones (e.g., pioglitazone), dipeptidyl peptidase IV inhibitors (e.g., sitagliptin), and αglucosidase inhibitors (e.g., acarbose).
These agents work by closing potassium channels on the surface of beta cells , which causes an influx of calcium ions into the cells and a consequent outflow of insulin from cellular storage vesicles. The thiazolidinediones (e.g., pioglitazone, rosiglitazone) decrease insulin resistance. .Types of antibiotic classes- mechanisms of action, indications for use, side effects, contraindications, and be able to identify by name Best antibiotic choice to treat specific organism (i.e., aerobic gram-negative, etc.)
Identify the difference between drug abuse, dependence, misuse, and tolerance Drug abuse - The use of illegal drugs or the use of prescription or over-the-counter drugs for purposes other than those for which they are meant to be used, or in excessive amounts. Drug abuse may lead to social, physical, emotional, and job-related problems. Drug dependence - Dependence on a drug means that your body has become so used to having that drug regularly that you need that particular drug to function normally, and if it were stopped you would feel unwell. Dependence, however, refers to the physical or psychological symptoms that occur that make someone feel like they must continue taking a substance. Misuse - the use of a substance for a purpose not consistent with legal or medical guidelines (WHO, 2006). It has a negative impact on health or functioning and may take the form of drug dependence, or be part of a wider spectrum of problematic or harmful behaviour (DH, 2006b).
Drug tolerance - A condition that occurs when the body gets used to a medicine so that either more medicine is needed or different medicine is needed. Sedative-hypnotic medications-mechanisms of action, indications for use, side effects, contraindications, and be able to identify by name Medications used for alcohol abuse and withdrawal Three drugs—naltrexone, acamprosate, and disulfiram—have FDA approval for adjunctive treatment of alcohol dependence.
Medications contraindicated in pregnancy Local anesthetics-mechanism of action, indications for use, and contraindications Rapid sequence intubation (RSI) agent classes- mechanisms of action, indications for use, side effects, contraindications, and be able to identify by name Medications indicated for general anesthesia-know mechanisms of action, indications for use, side effects, contraindications, and be able to identify by name
General anesthetics have been in clinical use for more than 170 years, but their mechanism of action remains unknown. The principal effect that is common to all anesthetic agents is suppression of the normal activity of the central nervous system (CNS). Initial research focused on identifying a single biologic site of action for these drugs. This “unitary theory” of anesthetic action has been supplanted by a more complex model of molecular targets located at multiple levels of the CNS. Ongoing research has focused on cellular, molecular, and network sites to understand the mechanism of general anesthesia. Intravenous nonopioid anesthetics play an essential role in the practice of modern anesthesia. They are used to facilitate rapid induction of anesthesia and have replaced inhalation as the preferred method of anesthesia induction in most settings except for pediatric anesthesia. Intravenous agents are also commonly used to provide sedation during monitored anesthesia care and for patients in ICU settings. With the introduction of propofol, intravenous anesthesia also became a good option for the maintenance of anesthesia. However, similar to the inhaled agents, the currently available intravenous anesthetics are not ideal anesthetic drugs in the sense of producing all and only the five desired effects (unconsciousness, amnesia, analgesia, inhibition of autonomic reflexes, and skeletal muscle relaxation). Therefore, balanced anesthesia employing multiple drugs (inhaled anesthetics, sedative-hypnotics, opioids, neuromuscular blocking drugs) is generally used to achieve the desired combination of effects while minimizing unwanted effects. Side effects - An interesting and desirable side effect of propofol is its antiemetic activity. Pain on injection is a common complaint and can be reduced by premedication with an opioid or coadministration with lidocaine. Dilution of propofol and the use of larger veins for injection can also reduce the incidence and severity of injection pain. ketamine is considered to be a cerebral vasodilator that increases cerebral blood flow, as well as CMRO 2. For these reasons, ketamine has traditionally not been recommended for use in patients with intracranial pathology, especially increased ICP. Contraindication – Dexmedetomidine, Diazepam, Etomidate, Ketamine, Lorazepam, Methohexital, Midazolam, Propofol, Thiopental Medications indicated for thyroid disorders- know mechanisms of action, indications for use, side effects, contraindications, monitoring, and be able to identify by name
