Periactin

By T. Hamil. DeSales University.

Precautons Patient with increased risk of bleeding from trauma discount 4 mg periactin, surgery or other pathological conditions effective 4 mg periactin, ulcers, renal impairment, hepatic impairment, history of bleeding or haemostatic disorder, pregnancy (Appendix 7c); interactions (Appendix 6c). Adult- Thrombosis: 2,50,000 units over 30 min, followed by 1,00,000 units every h for 12 to 72 h according to conditon with monitoring of clotng parameters. Contraindicatons Recent haemorrhage; surgery (including dental); parturiton; trauma; heavy vaginal bleeding; haemorrhagic stroke; history of cerebrovascular disease (especially recent or if residual disability); coma; severe hypertension; coagulaton defects; bleeding diatheses; aortc dissecton; risk of gastrointestnal bleeding such as recent history of peptc ulcer; oesophageal varices; ulceratve colits; acute pancreatts; severe liver disease; acute pulmonary disease with cavitaton; previous allergic reactons; pregnancy (Appendix 7c). Precautons Risk of bleeding from any invasive procedure; including injecton; external chest compres- sion; abdominal aneurysm or where throm- bolysis may give rise to embolic complica- tons such as enlarged lef atrium with atrial fbrillaton (risk of dissoluton of clot and sub- sequent embolizaton); diabetc retnopathy (small risk of retnal haemorrhage); recent or concurrent antcoagulant treatment; platelet count; fbrinogen level; thrombin and pro- thrombin tme. Storage Store in a sealed container protected from light in refrigerator (2 to 8⁰C). Urokinase* Pregnancy Category-C Schedule H Indicatons Acute myocardial infarcton; pulmonary embolism; deep vein thrombosis; peripheral vascular thrombosis; peripheral arterial thromboembolism; arterial thrombosis. Dose Intravenous infusion Deep vein thrombosis: 4,400 units/kg body weight in 15 ml Sodium Chloride (0. Contraindicatons In recent haemorrhage; trauma; or surgery (including dental extracton); coagulaton defects; bleeding diatheses; aortc dissecton; coma; history of cerebrovascular disease especially recent events or with any residual disability; recent symptoms of possible peptc ulceraton; heavy vaginal bleeding; severe hypertension; actve pulmonary disease with cavitaton; acute pancreatts; pericardits; bacterial endocardits; severe liver disease and oesophageal varices. They should also be used with cauton in external chest compression; pregnancy (Appendix 7c); elderly; hypertension; abdominal aneurysm or other conditons in which thrombolysis might give rise to embolic complicatons such as enlarged lef atrium with atrial fbrillaton (risk of dissoluton of clot and subsequent embolisaton); diabetc retnopathy (very small risk of retnal bleeding) and recent or concurrent use of drugs that increase the risk of bleeding; hematocrit platelet count; thrombin and prothrombin tme. Bleeding is usually limited to the site of injecton; but intracerebral haemorrhage or bleeding from other sites can occur. Serious bleeding calls for discontnuaton of the thrombolytc and may require administraton of coagulaton factors and antfbrinolytc drugs (aprotnin or tranexamic acid). Rarely, further embolism may occur (either due to clots that break away from the original thrombus or to cholesterol crystal emboli). It causes allergic reactons (including rash; fushing and uveits) and anaphylaxis has also been reported. Storage Store in a sealed container protected from light in refrigerator (2 to 8⁰C). The container should be sterile, tamper evident and sealed so as to exclude micro-organisms. They are rarely, needed when shock is due to Sodium and water depleton as, in these circumstances, the shock responds to water and electrolyte repleton. Plasma substtutes should not be used to maintain plasma volume in conditons such as burns or peritonits where there is loss of plasma protein, water and electrolytes over periods of several days. In these situatons, plasma or plasma protein frac- tons containing large amounts of albumin should be given. Plasma substtutes may be used as an immediate short-term measure to treat massive haemorrhage untl blood is avail- able, but large volumes of some plasma substtutes can increase the risk of bleeding by depletng coagulaton factors. Dextran may interfere with blood group cross-matching or biochemical measurements and these should be carried out before the infusion is started. Albumin* Pregnancy Category-C Indicatons Burns, hypoproteinaemia, shock, hypovolemia, acute liver failure, dialysis. Contraindicatons Congestve heart failure, severe anaemia, history of allergic reactons to human albumin; pregnancy (Appendix 7c). Administraton of albumin should be supplemented or replaced by packed red blood cells, history of cardiac or circulatory disease, increased capillary permeability. Adverse efects Allergic (or) pyrogenic reactons, tachycardia, rash, anaphylactc shock, increased salivaton. Human albumin stored at 2-8⁰C may be expected to contnue to meet the requirements of the monograph for fve years from the date on which it was heated at at 60⁰C for 10 hours. Human albumin stored at a temperature not exceeding 25⁰C may be expected to meet the requirements of the monograph for three years from the date on which it was heated at 60⁰C for 10 hours. Dextran 40* Pregnancy Category-C Schedule H Indicatons Plasma volume expansion during hypovolemic shock when blood not available, Prophylaxis of thromboembolic disorders to improve local circulaton in peripheral vascular occlusion. Dose Intravenous To improve local circulaton in peripheral vascular occlusion: Adult- 500-1000 ml (10- 20 ml/kg) in frst 24 hours; thereafer 500 ml every 1-2 days for up to 2 weeks. Thromboembolism prophylaxis: Adult- 500- 1000 ml (10-20 ml/kg) on day of surgery, then 500 ml daily for 2-3 days, then 500 ml every second or third day, for up to 2 weeks. Shock: Adult- initally 500-1000 ml (10-20 ml/ kg) infused as rapidly as needed; may follow with 500 ml (10 ml/kg) during the same 24 hour period; thereafer 500 ml (10 ml/kg) may be repeated daily for up to 5 days. Contraindicatons Hypersensitvity, cardiac decompensaton, oliguria or anuria, hemostatc defects, thrombocytopenia, blood coagulaton disorder, pulmonary oedema, neonates. Hydroxy Ethyl Starch* Pregnancy Category-C Indicatons Therapy for hypovolaemia, shock in surgery, trauma and infecton to improve haemody- namics, macrocirculaton, microcirculaton and oxygen supply; improve organ functon in blood loss. Contraindicatons Renal failure; haemorrhage; coagulaton disorders; anuria; oligouria. Precautons Should be used with cauton in patents with cardiac disease; liver disease; or renal impairment; urine output should be monitored. Care should be taken to avoid haematocrit concentraton from falling below 25-30% and the patent should be monitored for hypersensitvity reactons; bleeding disorder; sufcient fuid should be administered to avoid dehydraton; pregnancy (Appendix 7c).

Thyroid hormones affect protein and carbohy- drate metabolism and stimulate protein synthesis cheap 4mg periactin free shipping. They promote gluconeogenesis (the formation of glucose from free fatty acids and proteins) and increase the use of glycogen stores cheap 4 mg periactin overnight delivery. I can pump more and more They get the heart pumping… with thyroid Thyroid hormones increase heart rate and cardiac output (the hormones. They may even increase the heart’s sensitivity to catecholamines and in- crease the number of beta-adrenergic receptors in the heart (stimulation of beta receptors in the heart increases heart rate and contractility). Adverse reactions to thyroid drugs Most adverse reactions to Heart of the matter Toxic topics thyroid drugs result from Adverse reactions in the car- General manifestations of tox- toxicity. The drug of choice Levothyroxine is the drug of choice for thyroid hormone replace- ment and thyroid-stimulating hormone suppression therapy. Used for patients with hyperthyroidism (thyrotoxicosis), these drugs include: • thioamides, which include propylthiouracil and methimazole • iodides, which include stable iodine and radioactive iodine. In the Wolff- The antithesis to synthesis Chaikoff effect, excess iodine Thioamides block iodine’s ability to combine with tyrosine, there- decreases the by preventing thyroid hormone synthesis. Stable iodine inhibits hormone synthesis through the Wolff- Chaikoff effect, in which excess iodine decreases the formation and release of thyroid hormone. Warning: Radioactive material Radioactive iodine reduces hormone secre- tion by destroying thyroid tissue through in- duction of acute radiation thyroiditis (inflam- mation of the thyroid gland) and chronic gradual thyroid atrophy. Acute radiation thy- roiditis usually occurs 3 to 10 days after ad- ministering radioactive iodine. Pharmacotherapeutics Antithyroid drugs are commonly used to treat hyperthyroidism, especially in the form of Graves’ disease (hyperthyroidism caused by autoimmunity), which accounts for 85% of all cases. In case of removal To treat hyperthyroidism, the thyroid gland may be removed by surgery or destroyed by radiation. Stable iodine is also used after radioactive iodine therapy to control symptoms of hyperthyroidism while the radiation takes effect. Adverse If it gets too severe reactions to Propylthiouracil, which lowers serum T3 levels faster than methi- antithyroid mazole, is usually used for rapid improvement of severe hyperthy- drugs roidism. The most serious ad- When taking them for two verse reaction to Propylthiouracil is preferred over methimazole in pregnant thioamide therapy is women because its rapid action reduces transfer across the pla- granulocytopenia. Hy- cental barrier and it doesn’t cause aplasia cutis (a severe skin dis- persensitivity reactions order) in the fetus. Propylthiouracil and methimazole appear in breast milk, so it’s recommended that mothers taking these drugs shouldn’t breast- In bad taste feed. If a breast-feeding woman must take one of these drugs, The iodides can cause propylthiouracil is the preferred drug. Which signs indicate that a patient taking levothyroxine is ex- periencing thyroid toxicity? Diarrhea and weight loss are signs of thyroid toxicity in a patient taking levothyroxine. Oxytocin stimulates uterine contractions by increas- ing permeability of uterine cell membranes to sodium ions. Drugs and homeostasis Illness can easily disturb the homeostatic mechanisms that help maintain normal fluid and electrolyte balance. Such occurrences as loss of appetite, medication administration, vomiting, diarrhea, Look out! Electrolyte replacement drugs An electrolyte is a compound or element that carries an electrical charge when dissolved in water. Electrolyte replacement drugs are inorganic or organic salts that increase depleted or deficient electrolyte levels, helping to maintain homeostasis, the stability of body fluid composition and volume. Be- cause the body can’t store potassium, adequate amounts must be ingested daily. There, the enzyme adenosinetriphosphatase main- tains the concentration of potassium by pumping sodium out of Because the body the cell in exchange for potassium. It’s an essential element in deter- mining cell membrane potential and excitability. Potassium is necessary for proper functioning of all nerve and muscle cells and for nerve impulse transmission. It’s also essential for tissue growth and repair and for maintenance of acid-base balance. Pharmacotherapeutics (how drugs are used) Potassium replacement therapy corrects hypokalemia, low levels of potassium in the blood. Most adverse reactions Be still my heart to potassium are related Potassium decreases the toxic effects of digoxin. Because potassi- to the method of admin- um inhibits the excitability of the heart, normal potassium levels istration. Oral history Oral potassium some- Drug interactions times causes nausea, Potassium should be used cautiously in patients receiving vomiting, abdominal potassium-sparing diuretics (such as amiloride, spironolactone, pain, and diarrhea. When dietary intake isn’t enough to meet metabolic needs, pain at the injection site calcium stores in bone are reduced.

Pharmacodynamics It’s believed that oral antidiabetic drugs produce actions both within and outside the pancreas (extrapancreatic) to regulate blood glucose buy 4 mg periactin otc. Oral Pancreas partners antidiabetic drugs Oral antidiabetic drugs probably stimulate pancreatic beta cells to work in and out of release insulin in a patient with a minimally functioning pancreas buy discount periactin 4mg line. Most likely, it’s the actions of the oral antidiabetic agents outside of the pancreas that maintain this glucose control. Working beyond the pancreas Oral antidiabetic drugs provide several extrapancreatic actions to decrease and control blood glucose. They can go to work in the liver and decrease glucose production (gluconeogenesis) there. Also, by increasing the number of insulin receptors in the periph- eral tissues, they provide more opportunities for the cells to bind sufficiently with insulin, initiating the process of glucose metabolism. Pharmacotherapeutics Oral antidiabetic drugs are indicated for patients with type 2 dia- betes if diet and exercise can’t control blood glucose levels. These drugs aren’t effective in patients with type 1 diabetes because the patients’ pancreatic beta cells aren’t functioning at a minimal level. Safe and The old 1-2 punch sound Combinations of multiple oral antidiabetic drugs or an oral anti- diabetic drug with insulin therapy may be indicated for some pa- Cautionary tients who don’t respond to either therapy alone. Insulin therapy Getting too low is recommended in- Hypoglycemia may occur when sulfonylureas are combined with stead. It may also occur with a decline in kidney when metformin is combined with cimetidine, nifedipine, pro- function, and because cainamide, ranitidine, or vancomycin. Hypoglycemia is less likely the kidneys substantially to occur when metformin is used as a single agent. Glucagon Adverse Glucagon, a hyperglycemic drug that raises blood glucose levels, reactions is a hormone normally produced by the alpha cells of the islets of to oral Langerhans in the pancreas. Here Metabolism and excretion are some common ad- Glucagon is degraded extensively by the liver, kidneys, and plas- verse reactions to indi- ma, and at its tissue receptor sites in plasma membranes. It’s re- vidual oral antidiabetic moved from the body by the liver and the kidneys. Sulfonylureas Pharmacodynamics • Nausea Glucagon regulates the rate of glucose production through: • Epigastric fullness • glycogenolysis, the conversion of glycogen back into glucose by • Blood abnormalities the liver • Water retention • gluconeogenesis, the formation of glucose from free fatty acids • Rash and proteins • Hyponatremia • lipolysis, the release of fatty acids from adipose tissue for con- • Photosensitivity version to glucose. Metformin • Metallic taste Pharmacotherapeutics • Nausea and vomiting Glucagon is used for emergency treatment of severe hypoglyce- • Abdominal discomfort mia. Acarbose • Abdominal pain • Diarrhea Drug interactions • Flatulence Glucagon interacts adversely only with oral anticoagulants, in- creasing the tendency to bleed. How glucagon raises glucose levels When adequate stores of glycogen are present, glucagon can • This product initiates a series of reactions that result in an raise glucose levels in patients with severe hypoglycemia. What happens is easy to follow: • In this phosphorylated form, the large glucose molecule can’t • Initially, glucagon stimulates the formation of adenylate cy- pass through the cell membrane. To serve and protect Estrogens are used to correct estrogen-deficient states and, along with hormonal contraceptives, prevent pregnancy. Natural and synthetic estrogen Estrogens that treat endocrine system disorders include: • natural products, such as conjugated estrogenic sub- I take …and I’m stances, estradiol, and estropipate care of in charge of • synthetic estrogens, such as esterified estrogens, excretion… metabolism. Metabolism occurs in the liver, and the metabolites are excreted primarily by the kidneys. Pharmacodynamics The exact mechanism of action of estrogen isn’t clearly under- stood, but it’s believed to increase synthesis of deoxyribonucleic acid, ribonucleic acid, and protein in estrogen-responsive tissues in the female breast, urinary tract, and genital organs. Pharmacotherapeutics Estrogens are prescribed: • primarily for hormone replacement therapy in postmenopausal women to relieve symptoms caused by loss of ovarian function (see Hormone replacement therapy and heart disease, page 348) • less commonly for hormonal replacement therapy in women with primary ovarian failure or female hypogonadism (reduced hormonal secretion by the ovaries), for prevention and treatment of osteoporosis in postmenopausal women, and in patients who have undergone surgical castration • palliatively to treat advanced, inoperable breast cancer in post- menopausal women and prostate cancer in men. Hormone replacement therapy and heart disease Adverse reactions to Following a 5-year study, the Women’s Health Initiative reported increased risks of myocardial in- farction, stroke, breast cancer, pulmonary emboli, and deep vein thrombosis in women being estrogens treated with conjugated equine estrogens and progesterone as compared to those taking a Adverse reactions to es- placebo. Preventive Services Task Force recommends against the use of estrogen and pro- • hypertension gestin to prevent coronary heart disease in healthy women. Drug interactions Estrogens Relatively few drugs interact with estrogens: can be used to treat prostate • Estrogens may decrease the effects of anticoagulants, increas- cancer in men. The pituitary drugs consist of two groups: • Anterior pituitary drugs may be used diagnostically or therapeu- tically to control the function of other endocrine glands, such as the thyroid gland, adrenals, ovaries, and testes. Anterior pituitary drugs include: Anterior • adrenocorticotropics, which include corticotropin, corticotro- pituitary drugs act pin repository, corticotropin zinc hydroxide, and cosyntropin on endocrine • somatrem and somatropin, growth hormones glands to control their functions. Some of these hormones can be adminis- tered topically, but most require injection. Absorption, distribution, and metabolism Usually, natural hormones are absorbed, distributed, and metab- olized rapidly. Anterior pituitary hormone drugs are metabolized at the receptor site and in the liver and kidneys. Pharmacodynamics Anterior pituitary drugs exert a profound effect on the body’s growth and development. In turn, the pituitary gland secretes hor- mones that regulate secretions or functions of other glands. Concentrate on this formula The concentration of hormones in the blood helps determine hor- mone production rate.

To maintain adequate intravascular volume guided by blood pressure: • Sodium chloride 0 cheap periactin 4 mg without a prescription. For patients who remain symptomatically hypotensive: • Fludrocortisone order 4 mg periactin amex, oral, 50–100 mcg daily. With minor stress maintenance therapy should be doubled for the duration of illness and gradually tapered to usual dose. Low dose betamethasone (equivalent to dexamethasone) suppression test: • Betamethasone, oral, 1 mg. In patients with type 2 diabetes mellitus, appropriate weight loss if weight exceeds ideal weight. Measure HbA1c: » annually in patients who meet treatment goals, and » 3–6 monthly in patients whose therapy has changed until stable. In patients with severe target organ damage, therapy should be tailored on an individual patient basis and should focus on avoiding hypoglycaemia. Combination therapy with metformin plus a sulphonylurea is indicated if therapy with metformin alone (together with dietary modifications and physical activity/exercise) has not achieved the HbA1c target. For persisting HbA1c above acceptable levels and despite adequate adherence to oral hypoglycaemic agents, add insulin and withdraw sulphonylurea. Note: Secondary failure of oral agents occurs in about 5–10% of patients annually. Oral agents should not be used in type 1 diabetes, renal impairment or clinical liver failure. It is advisable to maintain all patients on metformin once therapy with insulin has been initiated. Insulin type Starting dose Increment Maximum daily dose Add on therapy: 10 units in the If 10 units not 40units • Intermediate evening before effective increase to long- bedtime, but not gradually to 20 Refer if > 40 acting after 22h00. In these situations, blood glucose monitoring must be done regularly (at least daily) in order to reduce the dose appropriately, reducing the risk of hypoglycaemia. To reduce cardiovascular risk All patients > 40 years of age should receive a statin e. Selection of insulin Basal bolus regimen All type 1 diabetics should preferentially be managed with combined intermediate-acting (basal) and short-acting insulin (bolus), the so-called basal bolus regimen. This consists of pre-meal short-acting insulin and bedtime intermediate-acting insulin not later than 22h00. The total dose is divided into: o 40–50% basal insulin o the rest as bolus insulin split equally before each meal. It is a practical option for patients who cannot monitor blood glucose frequently. Insulin delivery devices In visually impaired patients, prefilled syringes may be used. Home glucose monitoring Patients on basal/bolus insulin should measure glucose at least twice daily All patients with type 2 diabetes on insulin should be given test strips for home glucose monitoring appropriate for their care plan. Glucagon Type 1 diabetics, who are judged to be at high risk of hypoglycaemia should have a glucagon hypoglycaemia kit and both the patient and their family should be trained to use this emergency therapy. Once blood glucose is normal or elevated, and the patient is awake, check blood glucose hourly for several hours, and check serum potassium for hypokalaemia. If the patient has not regained consciousness after 30 minutes with a normal or elevated blood glucose, look for other causes of coma. Once the patient is awake, give a snack if possible, and admit for observation and education etc. If hypoglycaemia was caused by a sulphonylurea, the patient will require hospitalisation and a prolonged intravenous glucose infusion. Recurrent hypoglycaemia may be the cause of hypoglycaemic unawareness, which occurs frequently in type 1 diabetic patients. In some cases this situation can be restored to normal with avoidance of any hypoglycaemia for at least 2–4 weeks. Hyperglycaemic hyperosmolar state is a syndrome characterised by impaired consciousness, sometimes accompanied by seizures, extreme dehydration and severe hyperglycaemia, that is not accompanied by severe ketoacidosis (pH usually >7. If plasma glucose < 12 mmol/L, but ketones still present: • Dextrose 5% or dextrose 5% in sodium chloride 0. Cerebral oedema may occur with over-aggressive fluid replacement or rapid sodium change. Bicarbonate There is no proven role for the use of intravenous sodium bicarbonate and it could potentially cause harm. Insulin therapy Patients should be preferentially managed with protocol 1 (see below) in a high care ward, with appropriate monitoring. Note: Ketonaemia takes longer to clear than hyperglycaemia and combined insulin + and glucose (and K ) are needed to ensure clearance of ketonaemia.