what nature of the medication makes it necessary to use adjusted body weight?hydrophilic drugs(eg ☆aminoglycosides) pharmacologyUWorld HirotoShishido
example of noncompetitive antagonistsNorepinephrine (agonist) + phenoxybenzamine (noncompetitive antagonist) on α-receptors. pharmacologyUWorld HirotoShishido
indications of antiplatelet agent・irreversible COX inhibitor (aspirin)
Acute coronary syndrome
ischemic stroke
Primary and secondary prevention of cardiovascular disease (☆angina pectoris)
・ADP receptor inhibitor (clopidogrel)
Dual antiplatelet therapy (with acetylsalicylic acid) in
STEMI
Unstable angina/NSTEMI
Before PCI
☆Alternative to aspirin
adverse effects of donepezil(acetylcholine esterase inhibitor)
enhanced parasympathetic tone→
bradycardia, AV block→ reduced cardiac output→ ☆presyncope pharmacologyUWorld HirotoShishido
mechanism of tachyphylaxis against nasal decongestant spray☆Receptor inactivation & internalization by arrestins
Arrestin is a protein that prevents further G protein activation and links the receptor complex to clathrin, facilitating receptor endocytosis and depletion from the cell surface.
other examples of tachyphylaxis → bronchodilator(β-adrenergic), nitrates(decrease in NO production), desmopressin (depletion of vWF from endotgelial storage sites), barbiturates (induction of CYP450 enzyme) pharmacologyUWorld HirotoShishido
metabolism of benzopyrene(The ubiquitous compound can be found in coal tar, tobacco smoke and many foods, especially grilled meats.)
→can induce lung cancer
Pro-carcinogens are metabolized by cytochrome P450 ☆monooxygenase, an enzyme system present in hepatic ☆microsomes and the endoplasmic reticula of varied other tissues. Cytochrome P450 monooxygenase metabolizes steroids, alcohol, toxins, and other foreign substances by rendering them soluble and easier to excrete. pharmacologyUWorld HirotoShishido
short term treatment for rheumatoid arthritisNSAIDs, glucocorticoids can provide rapid symptom relief in the interim
disease-modifying agents (eg, methotrexate, sulfasalazine, hydroxychloroquine, minocycline), biologic agents (eg, TNF-α inhibitors)
→alleviate pain and inflammation and reduce long term joint destruction (the response typically takes weeks) rheumatologypharmacologyUWorld HirotoShishido
clinical use/ mechanism of action of imiquimodmany common dermatologic disorders associated with abnormal cell proliferation, including ☆anogenital warts (human papillomavirus virus infection), superficial basal cell carcinoma, and actinic keratosis
activation of ☆toll-like receptor 7, which upregulates the proinflammatory transcription factor nuclear factor-kappa B (NF-KB)
→ enhanced immune-mediated killing of aberrant cells dermatologypharmacologyUWorld HirotoShishido
thiazolidinedione mechanism of action(Pioglitazone, rosiglitazone)
↑Fatty acid uptake
weight gain
↑Adiponectin production
a cytokine secreted by fat tissue that lowers TG levels by ☆inducing differentiation of preadipocytes into insulin-responsive adipocytes and stimulates fatty
acid oxidation
treatment for hyperhidrosisSystemic anticholinergic medications (eg, oxybutynin), local anticholinergic injectable medications (eg, botulinum toxin), or surgical sympathectomy may be used to treat hyperhidrois.
Surgical sympathectomy for primary focal hyperhidrosis of the axilla uses electrocoagulation to target the ☆thoracic sympathetic trunk at the T2 sympathetic segment.
anticholinergic toxicityhot as a hare
dry as a bone
red as a beet
blind as a bat
mad as a hatter(CNS involvement)
→ ☆visual hallucination, confusion, seizure, psychosis
full as a flask
fast as a fiddle
treatment for myoclonic seizurebroad spectrum anticonvulsant (☆valproic acid, levetiracetam)
myoclonic seizure is often due to juvenile myoclonic epilepsy(JME)
A genetic epilepsy syndrome characterized by recurrent myoclonic seizures, generalized tonic-clonic seizures, and absence seizures. The onset of seizures occurs between the ages of 8 and 25, and seizures characteristically occur ☆immediately after waking up or following sleep deprivation. neurologypharmacologyUWorld HirotoShishido
administration of nitrateAround-the-clock nitrate administration (in any form) rapidly results in ☆development of tolerance to nitrates.
This is why a ☆nitrate-free interval must be provided every day in patients that are using daily long acting nitrates.
